Measuring Left Ventricular Dyssynchrony from ECG-gated Myocardial Perfusion SPECT

通过心电门控心肌灌注 SPECT 测量左心室不同步

• 批准号: 8311067
• 负责人: Ji Chen
• 金额: $ 38.36万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-07-15 至 2014-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8311067
• 关键词: Accounting; Acute; Admission activity; Affect; Cardiac; Cardiomyopathies; Clinical; Clinical Trials; Coupled; Data; Databases; Development; Diagnosis; Direct Costs; Echocardiography; Electrocardiogram; Evaluation; FDA approved; Facilities and Administrative Costs; Foundations; Goals; Heart failure; Hospitals; Image; Left; Left ventricular structure; Measurement; Measures; Mechanics; Myocardial perfusion; Patient Selection; Patients; Perfusion; Phase; Procedures; Refractory; Relaxation; Research; Simulate; Software Tools; Techniques; United States; Ventricular; base; conventional therapy; digital; improved; indexing; novel; outcome forecast; response; simulation; single photon emission computed tomography; software development; tool

RESEARCH SUMMARY Heart failure (HF) affects more than 5 million people in the United States, and the number increases by more than 0.5 million every year. Acute decompensated HF accounts for over one million hospital admissions per year. The estimated direct and indirect cost for HF in 2006 is $29.6 billion. Our long-term objective is to improve the prognosis of HF patients by more accurately predicting their response to cardiac resynchronization therapy (CRT) and/or revascularization. CRT has been approved by FDA as a treatment of HF patients refractory to conventional therapy. However, 20-40% of the patients who selected for CRT based on the conventional criteria do not respond to CRT. Echocardiography has shown to improve patient selection for CRT, but it requires expertise to obtain reliable results. The PROSPECT trial has shown that under "real-world" conditions the current available echocardiographic techniques are not ready for routine prediction of CRT response. Our primary goal is to predict the response to CRT in patients with HF-induced conduction disturbances and ventricular dyssynchrony. It will be accomplished by improved diagnosis and characterization of left ventricular (LV) dyssynchrony using our novel, quantitative multi-harmonic phase analysis (MHPA) of ECG-gated single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) study and by integrating this evaluation of LV dyssynchrony to our established quantification of myocardial perfusion and viability from the same study. This integrated quantification will also be used to predict the response to revascularization in HF patients with ischemic cardiomyopathy - our secondary goal. We propose to measure LV dyssynchrony from ECG-gated SPECT MPI, because 1) it is widely available, 2) it is highly reproducible, and 3) it can provide additional perfusion/viability information, which is needed for the management of the HF patient, without any additional procedure. Specifically, in this research we will 1) develop LV dyssynchrony simulation tools that can simulate gated SPECT MPI studies with a variety of LV dyssynchrony patters, 2) develop MHPA and optimize it by using the simulation tools to determine the imaging requirements for accurate MHPA measurements, 3) define and validate quantitative indices that describe LV dyssynchrony and development normal databases for these indices, 4) use the LV dyssynchrony quantification coupled with our established perfusion/viability quantification to predict the response to CRT in HF patients, and 5) use the integrated quantification of LV dyssynchrony, perfusion, and viability to predict the response to revascularization in HF patients with ischemic cardiomyopathy. Upon completion of this research, we will establish a strong scientific foundation for our phase analysis approach thus supporting a large clinical trial to prove the usefulness of ECG-gated SPECT MPI with our integrated quantification of LV dyssynchrony, perfusion, and viability in prognosis for HF patients and thus promoting widespread utilization clinically.

研究综述 心力衰竭（HF）影响了美国超过500万人，并且人数增加 每年超过50万。急性失代偿性HF占超过100万例住院病例 每一年。估计2006年HF的直接和间接成本为296亿美元。我们长远的目标是 通过更准确地预测心力衰竭患者对心脏栓塞的反应，改善其预后 治疗（CRT）和/或血管重建。CRT已被FDA批准用于HF患者的治疗 对常规治疗无效。然而，20-40%的患者选择CRT是基于 常规标准不响应CRT。超声心动图显示， CRT，但它需要专业知识，以获得可靠的结果。前景试验表明，在“现实世界”中， 目前可用的超声心动图技术还不能用于CRT的常规预测 反应我们的主要目标是预测HF诱导传导患者对CRT的反应 紊乱和心室不同步。它将通过改进诊断和表征来实现 左心室（LV）不同步使用我们的新的，定量多谐波相位分析（MHPA）， 心电图门控单光子发射计算机断层扫描（SPECT）心肌灌注成像（MPI）研究 通过将LV不同步性的评估与我们建立的心肌灌注定量相结合， 和生存能力的数据。这种综合量化也将用于预测对 缺血性心肌病心力衰竭患者的血运重建-我们的第二个目标。我们建议测量 ECG门控SPECT MPI的LV不同步，因为1）它广泛可用，2）它具有高度重现性， 以及3）它可以提供额外的灌注/存活信息，这是HF管理所需要的 患者，无需任何额外的手术。具体来说，在这项研究中，我们将1）发展左心室不同步 模拟工具，可模拟具有各种LV不同步模式的门控SPECT MPI研究，2） 开发MHPA并通过使用仿真工具对其进行优化，以确定成像要求， 准确的MHPA测量，3）定义和验证描述LV不同步的定量指标， 开发这些指标的正常数据库，4）使用LV不同步量化，结合我们的 已建立的灌注/活力定量预测HF患者对CRT的反应，以及5）使用 LV不同步、灌注和存活率的综合定量，以预测对 缺血性心肌病心力衰竭患者的血运重建。在完成这项研究后，我们将 为我们的阶段分析方法建立强大的科学基础，从而支持大型临床试验， 证明ECG门控SPECT MPI与我们的LV不同步综合定量的有用性， 灌注和存活性，从而促进临床上的广泛应用。

项目成果

SPECT myocardial perfusion imaging for the assessment of left ventricular mechanical dyssynchrony.

• DOI: 10.1007/s12350-011-9392-x
• 发表时间: 2011-08
• 期刊: Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology
• 作者: Chen J;Garcia EV;Bax JJ;Iskandrian AE;Borges-Neto S;Soman P
• 通讯作者: Soman P

The acute and chronic effects of different right ventricular site pacing on left ventricular mechanical synchrony as assessed by phase analysis of SPECT myocardial perfusion imaging.

通过 SPECT 心肌灌注成像相位分析评估右心室不同部位起搏对左心室机械同步性的急性和慢性影响。

• DOI: 10.1007/s12350-014-9912-6
• 发表时间: 2014
• 期刊: Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology
• 作者: Zhang,Hongxiang;Hou,Xiaofeng;Wang,Yao;Xue,Sheliang;Cao,Kejiang;Chen,Ji;Zou,Jiangang
• 通讯作者: Zou,Jiangang

Left Ventricular Dyssynchrony Parameters Measured by Phase Analysis of Post-stress and Resting Gated SPECT Myocardial Perfusion Imaging.

通过应力后相位分析和静息门控 SPECT 心肌灌注成像测量左心室不同步参数。

• DOI: 10.4103/1450-1147.113931
• 发表时间: 2013
• 期刊: World journal of nuclear medicine
• 影响因子: 0.6
• 作者: Zhou,Yanli;Li,Dianfu;Feng,Jianlin;Yuan,Donglan;Patel,Zenic;Cao,Kejiang;Chen,Ji
• 通讯作者: Chen,Ji

I-123 mIBG and Tc-99m myocardial SPECT imaging to predict inducibility of ventricular arrhythmia on electrophysiology testing: a retrospective analysis.

I-123 mIBG 和 Tc-99m 心肌 SPECT 成像预测电生理测试诱发室性心律失常的可能性：回顾性分析。

• DOI: 10.1007/s12350-014-9911-7
• 发表时间: 2014
• 期刊: Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology
• 作者: Zhou,Yanli;Zhou,Weihua;Folks,RussellD;Manatunga,DayaN;Jacobson,ArnoldF;Bax,JeroenJ;Garcia,ErnestV;Chen,Ji
• 通讯作者: Chen,Ji

Nonechocardiographic imaging in evaluation for cardiac resynchronization therapy.

• DOI: 10.1161/circimaging.111.963504
• 发表时间: 2011-05
• 期刊: Circulation. Cardiovascular imaging
• 作者: AlJaroudi W;Chen J;Jaber WA;Lloyd SG;Cerqueira MD;Marwick T
• 通讯作者: Marwick T