An Integrated and Automated Tool for Quantification of Biomechanics in Fetal and Neonatal Echocardiography

用于量化胎儿和新生儿超声心动图生物力学的集成自动化工具

• 批准号: 10704636
• 负责人: Ronald Mark Payne
• 金额: $ 18.97万
• 依托单位: PURDUE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-15 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10704636
• 关键词: Adult; Age; Age Years; Algorithmic Analysis; Biomechanics; Biomedical Engineering; Birth; Cardiac; Cessation of life; Child; Childhood; Clinical; Clinical Management; Clinical Sciences; Color; Common Ventricle; Computer software; Congenital Abnormality; Data; Development; Diagnosis; Diagnostic; Diastolic blood pressure; Dimensions; Disease; Disease-Free Survival; EFRAC; Echocardiography; Evolution; Failure; Fetal Heart; Fontan Procedure; Functional disorder; Goals; Growth; Heart; Heart Ventricle; Heart failure; Hypoplastic Left Heart Syndrome; Indiana; Infant; Infrastructure; Intervention; Measurement; Measures; Mechanics; Methods; Morphology; Neonatal; Operative Surgical Procedures; Outcome; Palliative Surgery; Patient-Focused Outcomes; Patients; Pattern; Pediatric Hospitals; Pediatric cardiology; Physiologic intraventricular pressure; Pregnancy; Prognosis; Reproducibility; Scanning; Single ventricle congenital heart disease; Survival Rate; Testing; Time; Transcend; Universities; Ventricular; Work; automated analysis; clinical practice; clinical prognosis; comparison control; congenital heart disorder; design; fetal; heart function; hemodynamics; improved; improved outcome; longitudinal analysis; longitudinal, prospective study; medical schools; novel; outcome prediction; palliation; patient stratification; pediatric heart failure; pediatric patients; postnatal; precision medicine; predictive tools; prenatal; pressure; prognostic; prospective; risk stratification; success; tool

PROJECT SUMMARY The single ventricle (SV) heart is a critical birth defect that requires several palliative surgeries for patient survival. Even when these surgeries are considered successful, SV hearts can develop heart failure (HF), resulting in just a 43% 30-years of age survival rate for patients. The SV's biomechanics underlying the progression to HF could provide critical enabling information that could help improve SV patients' outcomes and surgical planning. Despite that, SV biomechanics remain not well understood. Existing echocardiography analysis tools are designed for adult hearts and cannot accurately or reproducibly evaluate fetal and neonatal echocardiograms. Thus, currently, there are no available tools to study the biomechanics of SV hearts. Beyond this, conventional metrics such as ejection fraction (EF) fail to capture SV hearts' growth and remodeling. We previously developed a novel, automated analysis tools that can quantify ventricular biomechanics from routine B-mode and color Doppler recordings. We tested these tools using pre- and postnatal normal and hypoplastic left heart patients. We simultaneously measured conventional metrics (e.g., EF), global longitudinal strain and strain rate, interventricular pressure difference, and flow energy losses. Such measurements have never been possible using existing echocardiogram analysis tools. Our initial findings indicated these metrics differed between SV and normal postnatal hearts, with statistical significance. We propose to test the hypothesis that differences in diastolic flow, pressure, and energy-loss, correlate with pre- and post-Fontan procedure outcomes and predict progression to failure. We will aim to (i) optimize and establish the accuracy and reliability of our novel and integrated echocardiography analysis for SV hearts and subsequently use our tools to establish quantitative biomechanics and hemodynamic differences between healthy and SV hearts. Further, we aim to: (ii) analyze SV hearts using a prospective longitudinal study to develop correlations between the evolution of hemodynamics and biomechanics parameters of SV hearts with time-point outcomes, such as growth and event-free survival at fetal, neonatal, and pre- and post-Fontan stages. This project aims to improve predictions of outcomes and enable better surgical planning and clinical management for children with SV heart defects. This project's goal would be to establish our tools in clinical practice.

项目总结 单心室(SV)心脏是一种严重的出生缺陷，患者需要进行几次姑息性手术。 生死存亡。即使这些手术被认为是成功的，SV心脏也可能发展为心力衰竭(HF)， 导致患者30岁的存活率仅为43%。SV的生物力学基础上 进展到心衰可以提供关键的使能信息，有助于改善SV患者的预后和 外科手术计划。尽管如此，SV的生物力学仍然没有得到很好的理解。现有的超声心动图 分析工具是为成人心脏设计的，不能准确或重复地评估胎儿和新生儿 超声心动图。因此，目前还没有可用的工具来研究心脏的生物力学。 除此之外，射血分数(EF)等常规指标无法反映SV心脏的生长和重构。 我们之前开发了一种新型的自动化分析工具，可以从 常规B超和彩色多普勒记录。我们使用出生前和出生后的正常和 左心发育不全患者。我们同时测量了常规指标(例如EF)、全球纵向指标 应变和应变率、室间压差和流动能量损失。这样的测量已经 使用现有的超声心动图分析工具是不可能的。我们的初步发现表明，这些指标 心动过速与正常生后心脏的差异有统计学意义。 我们建议检验这一假设，即舒张期血流、压力和能量损失的差异， 与Fontan手术前后的结果相关，并预测进展为失败。我们将瞄准 为了(I)优化和确定我们新的集成超声心动图的准确性和可靠性 对心脏进行分析，然后使用我们的工具建立定量的生物力学和 健康心脏和SV心脏的血流动力学差异。此外，我们的目标是：(Ii)使用一个 前瞻性纵向研究，以发展血流动力学演变和 SV心脏的生物力学参数与时间点结果，如胎儿生长和无事件存活， 新生儿期、丰坦期前后。 该项目旨在改善对结果的预测，并使更好的手术计划和临床 室性心动过速患儿的处理。该项目的目标将是在临床上建立我们的工具 练习一下。