Volumetric Echocardiographic Particle Image Velocimetry for Grading the Severity of Mitral Valve Regurgitation

用于对二尖瓣反流严重程度进行分级的体积超声心动图粒子图像测速

• 批准号: 10847737
• 负责人: Arash Kheradvar
• 金额: $ 64.53万
• 依托单位: UNIVERSITY OF CALIFORNIA-IRVINE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-01-15 至 2026-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10847737
• 关键词: 3-Dimensional; Admission activity; Affect; Age; Award; Blood Flow Velocity; Blood flow; Cardiac Catheterization Procedures; Clinical; Clinical Protocols; Code; Contrast Echocardiography; Contrast Media; Control Groups; Data; Decision Making; Detection; Development; Diagnosis; Disease; Echocardiography; Equation; Feasibility Studies; France; Functional disorder; Funding; Healthcare; Heart; Heart failure; Hospitals; Image; Individual; Inpatients; Intervention; Left; Left atrial structure; Left ventricular structure; Measures; Medical center; Methodology; Mitral Valve; Mitral Valve Insufficiency; Monitor; Morbidity - disease rate; Outcome; Patient Discharge; Patients; Population; Prevalence; Procedures; Process; Prospective cohort; Protocols documentation; Pulmonary Hypertension; Reporting; Research; Right ventricular structure; Severities; Speed; Symptoms; System; Techniques; Testing; Therapeutic; Three-Dimensional Echocardiography; Three-Dimensional Imaging; Ultrasonic Transducer; United States; Velocimetries; Ventricular; Visualization; care burden; clinical research site; contrast enhanced; cost; experience; follow-up; hemodynamics; imaging modality; indexing; inter-institutional; mortality; novel; overtreatment; particle; prevent; success; tool; ultrasound; vector

PROJECT SUMMARY/ABSTRACT Optimal management of patients with mitral regurgitation (MR) involves accurate grading for the disease timely intervention, proper follow-up, and patient-specific therapeutic decision-making. A recent study in France showed that although MR was clearly identified and coded in the patients' discharge summary, only less than 10% of those admitted with significant MR underwent a valve intervention within 1 year. This leaves a vast majority of the patients untreated. They found that the rate of mitral valve intervention was significantly low for both primary and secondary MR. This high level of undertreatment is even more striking considering that all individuals were inpatients, admitted to French hospitals with relatively easy access to cardiologists. Alternatively, a significant and unfortunate outcome of inaccurate grading of MR severity is over-treatment of the patients whose grade of valve regurgitation has been erroneously reported. Every so often patients undergo unnecessary corrective procedures due to misgrading their MR. The under- or over-treatment is a significant and unfortunate outcome of inaccurate grading of MR severity. Volumetric Echo-PIV visualizes and quantifies 3D blood flow velocity field from echocardiographic data based on the governing equations of the flow. Given the ubiquitous availability of the echocardiography systems, V- Echo-PIV is inexpensive, accurate, and accessible. Funded by 1 R01 HL153724-01A1, we are currently studying the feasibility of V-Echo-PIV as a tool to assess right ventricular (RV) flow for diagnosis and follow up of patients with pulmonary hypertension (PH). These patients require frequent monitoring, often including repeated invasive right heart catheterization (RHC) due to their clinical status, which has led to a significant healthcare burden. Noninvasively derived RV hemodynamics indices from V-Echo-PIV that correlate with PH patients' clinical condition could significantly reduce the cost and morbidity of the current invasive tests. Based on our recent success in characterizing the RV blood flow in the PH patients and healthy control subjects, this supplement award seeks to study the feasibility of V-Echo-PIV to quantify MR and thus eliminate intra- and inter-operator variability in grading MR. V-Echo-PIV utilizes matrix array ultrasound transducers of current standard echocardiography systems and requires only a few heartbeats (up to 4) to process and obtain the blood flow's 3D velocity vector field in the heart chambers. We hypothesize that by measuring the 3D velocity field in the left ventricle and left atrium via V-Echo-PIV, it is possible to characterize the flow conversion zone in 3D and accurately grade MR. To achieve the proposed research objectives, the following specific aims are set to be accomplished in a 1-year duration of the project: SPECIFIC AIM 1: Devise a protocol for high-speed contrast 3D echocardiography to image the flow in the left heart to characterize and grade mitral valve regurgitation. SPECIFIC AIM 2: Characterize the flow conversion zone in 3D by means of V-Echo-PIV in a prospective cohort of patients with mitral valve regurgitation to accurately grade MR severity.

项目总结/摘要 二尖瓣返流（MR）患者的最佳管理包括及时对疾病进行准确分级 干预，适当的后续行动，和患者的具体治疗决策。法国最近的一项研究表明， 尽管MR在患者的出院总结中被明确识别和编码，但只有不到10%的 严重二尖瓣返流患者在1年内接受了瓣膜介入治疗。这使得绝大多数 患者未经治疗。他们发现，二尖瓣介入治疗的比率对于两种原发性高血压患者都明显较低， 这种高水平的治疗不足是更惊人的，考虑到所有的人都是 住院患者，入住法国医院，相对容易获得心脏病专家。或者，一个重要的 MR严重程度分级不准确的不幸结果是过度治疗的患者， 错误报告了瓣膜返流。有时病人会接受不必要的矫正 由于错误地对他们的MR进行分级而导致的手术。治疗不足或过度是一个重大而不幸的结果 MR严重程度分级不准确。 体积Echo-PIV可根据超声心动图数据可视化和量化3D血流速度场， 关于流动的控制方程。鉴于超声心动图系统的普遍可用性，V- Echo-PIV价格便宜，准确，易于使用。由1 R 01 HL 153724 - 01 A1资助，我们目前正在研究 V-Echo-PIV作为右心室（RV）血流评价工具用于诊断和随访患者可行性 肺动脉高压（PH）这些患者需要频繁监测，通常包括反复侵入性监测。 右心导管插入术（RHC），由于他们的临床状况，这导致了显着的医疗保健负担。 从V-Echo-PIV中无创导出的与PH患者临床相关的RV血流动力学指标 条件可以显着降低成本和发病率目前的侵入性测试。 基于我们最近在PH患者和健康对照受试者中表征RV血流的成功， 该补充合同旨在研究V-Echo-PIV量化MR的可行性，从而消除内部和外部的MR。 分级MR中的操作员间可变性。V-Echo-PIV利用电流的矩阵阵列超声换能器 标准的超声心动图系统，并且仅需要几次心跳（最多4次）来处理和获取血液 心脏腔室中血流的3D速度矢量场。我们假设，通过测量三维速度场， 通过V-Echo-PIV测量左心室和左心房，可以在3D中表征血流转换区， 为达致建议的研究目标，我们会设定以下具体目标， 在项目的一年时间内完成： 具体目标1：设计高速对比3D超声心动图方案，以成像左侧血流 心脏来表征和分级二尖瓣返流。 特定目标2：在前瞻性队列中通过V-Echo-PIV在3D中表征血流转换区 二尖瓣返流患者的二尖瓣返流严重程度进行准确分级。