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.

项目摘要/摘要 二尖瓣反流(Mr)患者的最佳处理包括及时准确地对疾病进行分级。 干预，适当的随访，以及针对患者的治疗决策。法国最近的一项研究表明 虽然MR在患者出院摘要中被清楚地识别和编码，但只有不到10%的 那些因严重MR入院的患者在1年内接受了瓣膜介入治疗。这就留下了绝大多数 这些病人没有得到治疗。他们发现，二尖瓣介入治疗的发生率在两种情况下都很低。 而次要的先生，考虑到所有人都是 住院患者，住进法国医院，相对容易找到心脏病专家。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 错误地报道了瓣膜返流。患者偶尔会接受不必要的矫正 由于对他们的先生进行错误评级而进行的手术治疗不足或过度治疗是一个严重和不幸的结果 MR严重程度的不准确分级。 容积Echo-PIV根据超声心动图数据可视化和量化三维血流速度场 关于水流的控制方程。鉴于超声心动图系统无处不在，V- Echo-PIV是一种廉价、准确和易用的方法。由1 R01 HL153724-01A1资助，目前正在研究 V-Echo-PIV评价右室血流在诊断和随访中的可行性 合并肺动脉高压(PH)。这些患者需要经常监测，通常包括反复侵入性监测。 右心导管术(RHC)由于他们的临床状况，这导致了巨大的医疗负担。 V-Echo-PIV无创性获取与PH患者临床相关的RV血流动力学指标 条件可以显著降低目前侵入性检测的成本和发病率。 基于我们最近成功地表征了PH患者和健康对照受试者的右室血流， 本补充奖旨在研究V-Echo-PIV量化MR的可行性，从而消除Intra和 V-Echo-PIV分级中的操作员间可变性利用电流的矩阵阵列超声换能器 标准的超声心动图系统，只需要几次心跳(最多4次)就可以处理和获取血液 血流在心腔内的三维速度矢量场。我们假设通过测量三维速度场 通过V-Echo-PIV检查左心室和左心房，可以在3D和 为达到建议的研究目标，以下具体目标定为 在项目为期一年的时间内完成： 具体目标1：设计一种用于高速声学造影三维超声心动图以成像左侧血流的方案 心脏对二尖瓣返流的特征和分级。 具体目标2：在前瞻性队列中通过V-Echo-PIV在3D中表征血流转换区 对二尖瓣反流患者的MR严重程度进行准确分级。