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Impact of surgical revascularization strategy on left ventricular function, myocardial perfusion and clinical outcomes

手术血运重建策略对左心室功能、心肌灌注和临床结果的影响

基本信息

批准号：
10655480
负责人：
Lisa Qia Rong
金额：
$ 19.31万
依托单位：
WEILL MEDICAL COLL OF CORNELL UNIV
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-06-01 至 2026-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10655480
关键词：
3-Dimensional Anesthesia procedures Anesthetics Biometry Blood flow Cardiac Clinical Clinical Research Coronary Coronary Arteriosclerosis Coronary Artery Bypass Data Decision Making Echocardiography Face Flowmeters Fostering Funding Goals Grant Hour Image International Intervention Left Left Ventricular Ejection Fraction Left Ventricular Function Legal patent Length of Stay Link Low Cardiac Output Syndrome Measurement Mentorship Methodology Methods Monitor Morbidity - disease rate Myocardial Myocardial Infarction Myocardial Revascularization Myocardial dysfunction Myocardial perfusion New York City Operative Surgical Procedures Outcome Outcomes Research Parents Patient-Focused Outcomes Patients Performance Perfusion Perioperative Pharmaceutical Preparations Physiological Physiology Postoperative Period Prognosis Randomized Recovery Representational Oligonucleotide Microarray Analysis Research Research Personnel Resistance Risk Saphenous Vein Site Stress Surgeon Technical Expertise Techniques Testing Training Transesophageal Echocardiography Translating Translational Research United States Vascularization Vasoconstrictor Agents Vasodilator Agents Vein graft Venous Ventricular Writing cardiovascular imaging career contrast enhanced coronary perfusion data acquisition design evidence base experience follow-up heart function heart imaging hemodynamics imaging modality improved indexing insight mortality novel imaging technique operation pharmacologic predict clinical outcome prospective randomized, clinical trials response revascularization surgery skills stem surgery outcome

项目摘要

Project Summary Coronary artery disease (CAD) is a leading cause of morbidity and mortality: revascularization via coronary artery bypass grafting (CABG) is a common therapy for CAD, which is performed via either single arterial graft (SAG) or multiple arterial grafting (MAG) strategies. Whereas arterial grafts have better long-term patency than vein grafts, data indicates that patients receiving MAG may experience higher perioperative risk. Cardiac function is known to predict prognosis after CABG, but the impact of different revascularization approaches on cardiac performance and consequences on clinical outcomes are incompletely understood. In this re- submission K23 proposal, I will build on my background in cardiothoracic anesthesia and advanced echo imaging to elucidate the effect of the two different revascularization strategies (SAG vs. MAG) on cardiac function immediately after CABG and subsequent clinical outcomes, in order to provide a framework for perioperative management of CABG patients. In Aim 1, I will examine the impact of CABG revascularization strategy on the change in cardiac function defined by echo strain. I will identify if MAG will result in lower cardiac performance as quantified by transesophageal echocardiography from baseline to after the operation. I will also evaluate whether the change echo strain will be associated with medications need to support hemodynamics. In Aim 2, I will determine the mechanism by which echo strain decreases after CABG. Myocardial perfusion on contrast-enhanced echo and flowmeter will be utilized to test the association with cardiac functional change (echo strain). I will also evaluate if MAG will result in lower myocardial perfusion than will SAG-based revascularization. In Aim 3, I will determine whether the decrease in echo strain predicts clinical outcomes at 6 months better than conventional imaging indices. By studying the link between revascularization techniques, cardiac function and physiology, I will lay the groundwork for a research career translating new insights regarding underlying mechanisms of cardiac dysfunction into meaningful anesthetic interventions that improve clinical outcomes. Under my strong mentorship team of Drs. Devereux (extensive expertise in cardiovascular imaging trials and cardiac outcomes research), Gaudino (internationally renowned cardiac surgeon with a focus on multi-arterial grafting and designing randomized clinical trials and m-PI of the funded parent trial ROMA), and Weinsaft (an expert in quantitative cardiac imaging and translational research), I will be able to enhance my clinical research skills while obtaining new technical skills advanced echocardiography and translational research that will allow me to become an independent investigator. In addition, new skills obtained from my K23 will directly guide the design of a planned R01 to (a) to assess LV response to vasoactive medications designed to improve arterial graft flow in CABG patients and (b) test vasodilator therapy to improve clinical outcomes in patients with MAG.

项目摘要冠状动脉疾病（CAD）是发病率和死亡率的主要原因：经冠状动脉的血运重建术是治疗冠心病的有效方法。动脉旁路移植术（CABG）是冠心病的常用治疗方法，通过单一动脉移植物进行 (SAG)或多动脉移植（MAG）策略。而动脉移植物的长期通畅性优于静脉移植物，数据表明接受MAG的患者可能会经历更高的围手术期风险。心脏已知功能可预测CABG后的预后，但不同的血运重建方法对心脏性能和对临床结果的影响还不完全清楚。在这场重新- 提交K23提案，我将以我在心胸麻醉和高级超声心动图方面的背景为基础成像以阐明两种不同血运重建策略（SAG与MAG）对心脏的影响。在CABG后立即功能和随后的临床结局，以便为 CABG患者的围手术期管理。在目标1中，我将研究CABG血运重建的影响根据超声应变定义的心脏功能变化的策略。我将确定MAG是否会降低通过经食管超声心动图从基线到手术后量化的心脏性能。我还将评估回声应变的变化是否与需要支持的药物相关血流动力学在目标2中，我将确定CABG后回波应变降低的机制。将使用对比增强回波和流量计上的心肌灌注来测试与以下各项的关联：心功能改变（回声应变）。我还将评估MAG是否会导致心肌灌注低于将进行基于SAG的血运重建。在目标3中，我将确定回波应变的降低是否预示着 6个月时的临床结局优于常规成像指标。通过研究再血管化技术，心脏功能和生理学，我将为研究生涯奠定基础将有关心功能不全潜在机制的新见解转化为有意义的麻醉剂改善临床结果的干预措施。在Devereux博士的强大指导团队（广泛心血管成像试验和心脏结局研究方面的专业知识）、高迪诺（国际知名心脏外科医生，重点是多动脉移植和设计随机临床试验和m-PI的资助的母试验ROMA）和Weinsaft（定量心脏成像和转化研究专家），我将能够提高我的临床研究技能，同时获得新的技术技能先进超声心动图和转化研究，这将使我成为一个独立的调查员。在此外，从我的K23获得的新技能将直接指导计划中的R 01的设计，以（a）评估LV 对旨在改善CABG患者动脉移植物血流的血管活性药物的反应和（B）试验血管扩张剂治疗，以改善MAG患者的临床结局。

项目成果

期刊论文数量（16）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

The evolving role of dexmedetomidine in pediatric cardiac surgery: Beyond anxiolysis.

右美托汀在小儿心脏手术中的不断发展的作用：超越抗焦虑。

DOI：
10.1111/jocs.16706
发表时间：
2022-12
期刊：
JOURNAL OF CARDIAC SURGERY
影响因子：
1.6
作者：
Scharoun, Jacques;Rong, Lisa Q.
通讯作者：
Rong, Lisa Q.

Awaiting the Renaissance of the Anesthesiologist-Scientist.

等待麻醉师科学家的复兴。

DOI：
10.1053/j.jvca.2022.04.015
发表时间：
2022
期刊：
Journal of cardiothoracic and vascular anesthesia
影响因子：
2.8
作者：
Chan,June;Rong,LisaQ
通讯作者：
Rong,LisaQ

Left Atrial Strain Quantification by Intraoperative Transesophageal Echocardiography: Validation With Transthoracic Echocardiography.

通过术中的媒介物超声心动图：经胸膜超声心动图的验证。

DOI：
10.1053/j.jvca.2021.11.017
发表时间：
2022-08
期刊：
Journal of cardiothoracic and vascular anesthesia
影响因子：
2.8
作者：
通讯作者：

In Response.

在回应中。

DOI：
10.1097/mcg.0000000000000451
发表时间：
2016
期刊：
Journal of clinical gastroenterology
影响因子：
2.9
作者：
Dasarathy,Srinivasan;Dasarathy,Jaividhya;Khiyami,Amer;Yerian,Lisa;McCullough,ArthurJ
通讯作者：
McCullough,ArthurJ

A Systematic Review of Retractions in the Field of Cardiothoracic and Vascular Anesthesia.