The state of energy in the right ventricle of patients with pulmonary arterial hypertension

肺动脉高压患者右心室能量状态

• 批准号: 10358990
• 负责人: Arash Kheradvar
• 金额: $ 67.19万
• 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/10358990
• 关键词: 3-Dimensional; Address; Assessment tool; Blood; Blood flow; Cardiac Catheterization Procedures; Chronic; Clinical; Data; Deterioration; Diagnosis; Dimensions; Disease Progression; Disease regression; Echocardiography; Gold; Healthcare; Heart; Heart Diseases; Human; Hypertension; Image; Kinetics; Measurement; Measures; Medical center; Methods; Monitor; Morbidity - disease rate; Nature; Patients; Periodicity; Process; Pulmonary Heart Disease; Reference Standards; Reproducibility; Right Ventricular Dysfunction; Right ventricular structure; Structure; Study Subject; Techniques; Testing; Time; Velocimetries; Ventricular; Work; advanced disease; base; cardiac magnetic resonance imaging; clinical diagnosis; cohort; cost; ethnic diversity; experience; feasibility testing; follow-up; hemodynamics; imaging modality; mortality; non-invasive imaging; particle; pressure; prospective; pulmonary arterial hypertension; pulmonary arterial pressure; right ventricular failure; standard of care; success; two-dimensional

PROJECT SUMMARY/ABSTRACT Pulmonary arterial hypertension (PAH) is a progressive cardiopulmonary disease with a high mortality rate. In most cases, PAH-induced chronic pressure overload leads to right ventricle (RV) failure. Right heart catheterization (RHC) is currently the gold standard test for PAH diagnosis and follow-up. Furthermore, repeated RHC should be considered in patients who experience unexplained clinical deterioration during their clinical course or for periodic follow-up over time. Yet many centers across the world do not routinely perform RHC during follow-up, for a variety of potential reasons, including its invasive nature, cost, or availability. We have recently developed 3D echocardiographic particle image velocimetry (Echo-PIV), which allows high- temporal volumetric assessment of RV hemodynamics. In combination with standard 3D speckle tracking, 3D Echo-PIV enables a comprehensive assessment of hemodynamics and energy state (ventricular kinetic energy/work and viscous energy dissipation) in the RV. The RV energy state reflects the structural and functional changes in the RV that may occur due to PAH. Thus, it can be used as a load-independent measure to assess RV function and monitor disease progression/regression in PAH patients. The project's global hypothesis is that in PAH patients' follow-up, changes in the RV energy state: (1) reflect changes in RHC-derived pulmonary arterial pressures, and (2) are associated with changes in patients' clinical status such that it can be used to monitor disease progression and regression. Given that in more advanced disease, RV dysfunction is present, we will gather a prospective, ethnically diverse cohort of 210 subjects at Cedars-Sinai Medical Center: 70 PAH patients with normal RV function, 70 PAH patients with RV dysfunction, and 70 healthy control subjects. The following Specific Aims will be accomplished: SPECIFIC AIM 1: Investigate the accuracy of 3D Echo-PIV in characterizing 4D flow hemodynamics in the RV using 4D Flow CMR as a reference standard and assess test/retest reproducibility of 3D Echo-PIV in PAH. SPECIFIC AIM 2: Determine the relationship between the noninvasively derived RV energy state and RHC- derived parameters in following up PAH patients and test whether changes in the RV energy state reflect changes in the RHC-derived pulmonary arterial pressures in PAH patients with and without RV dysfunction. SPECIFIC AIM 3: Investigate the feasibility of noninvasive imaging-derived RV energy state for monitoring disease progression/regression in PAH patients. The success of the proposed studies will establish 3D Echo-PIV as a tool for assessment of PAH patients and will: (1) determine the relationship between noninvasive RV imaging and invasive RHC-based hemodynamics, (2) establish whether changes in noninvasive RV energy state reflect changes in the RHC-derived parameters in PAH patients, and (3) facilitate monitoring of disease progression/regression by noninvasive RV energy state in lieu of invasive RHC (current clinical gold standard).

项目摘要/摘要 肺动脉高压(PAH)是一种病死率较高的进展性心肺疾病。在……里面 大多数情况下，PAH引起的慢性压力超负荷导致右室(RV)衰竭。右心 导管检查(RHC)是目前诊断和随访PAH的金标准检查。此外，重复 对于在临床上经历不明原因的临床恶化的患者，应该考虑RHC。 当然，也可以随时间的推移进行定期的跟踪。然而，世界各地的许多中心并不定期进行RHC 在随访期间，由于各种潜在原因，包括其侵入性、成本或可用性。 我们最近开发了三维超声心动图粒子图像测速仪(Echo-PIV)，它允许高分辨率的 右室血流动力学的暂时性容量评价。与标准的3D斑点跟踪相结合 ECHO-PIV能够全面评估血流动力学和能量状态(心室运动 能量/功和粘性能量耗散)。房车的能量状态反映了结构和功能 房车可能因PAH而发生的变化。因此，它可以作为一种与负载无关的度量来评估 监测PAH患者的右室功能和病情进展/消退。 该项目的总体假设是，在PAH患者的随访中，RV能量状态的变化：(1)反映 RHC来源的肺动脉压的变化，以及(2)与患者临床的变化有关 状态，以便可以用来监测疾病的进展和消退。 考虑到在更晚期的疾病中，RV功能障碍是存在的，我们将聚集一个预期的、种族多样的 锡达斯-西奈医学中心210例受试者的队列：70例右室功能正常的PAH患者，70例PAH患者 右室功能障碍患者70例，健康对照组70例。实现以下具体目标： 具体目标1：探讨3D Echo-PIV评价右室4D血流动力学的准确性 以4D Flow CMR为参照标准，评价3D Echo-PIV在PAH中的测试/复测重复性。 具体目的2：确定非侵入性RV能量状态与RHC- 对PAH患者进行随访并测试RV能量状态的变化是否反映了 伴和不伴右室功能障碍的PAH患者RHC来源的肺动脉压的变化。 具体目标3：研究无创成像获取的RV能量状态用于监测的可行性 PAH患者的疾病进展/消退。 拟议研究的成功将建立3D Echo-PIV作为评估PAH患者和 将：(1)确定无创性RV成像与有创性RHC血流动力学的关系， (2)确定非侵入性RV能量状态的变化是否反映RHC派生参数的变化 在PAH患者中，以及(3)通过非侵入性RV能量状态促进对疾病进展/退化的监测 以代替侵袭性RHC(当前临床黄金标准)。