Improving Phenotypic Classification and Prediction of Treatment Outcomes in Patients with Non-ischemic Cardiomyopathy and Functional Mitral Regurgitation

改善非缺血性心肌病和功能性二尖瓣反流患者的表型分类和治疗结果预测

• 批准号: 10717066
• 负责人: DEBORAH KWON
• 金额: $ 77.74万
• 依托单位: CLEVELAND CLINIC LERNER COM-CWRU
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-10 至 2028-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10717066
• 关键词: Address; Anatomy; Biological; Cardiac; Cardiomyopathies; Cardiovascular system; Characteristics; Classification; Clinical; Clinical Trials; Complex; Consensus; Databases; Devices; Dimensions; Disease-Free Survival; Echocardiography; Evolution; Goals; Guidelines; Heart failure; Heterogeneity; Infarction; Intervention; Ischemia; Left; Left Ventricular Remodeling; Longitudinal Studies; Machine Learning; Magnetic Resonance; Medical; Methods; Mitral Valve; Mitral Valve Insufficiency; Modernization; Outcome; Outcome Assessment; Patient Selection; Patients; Pattern; Phenotype; Positioning Attribute; Prediction of Response to Therapy; Prevalence; Process; Prognosis; Reproducibility; Research; Risk; Selection Criteria; Severities; Testing; Texture; Therapeutic; Tissues; Treatment Failure; Treatment outcome; United States; Ventricular; analytical method; biological heterogeneity; cardiac magnetic resonance imaging; clinical heterogeneity; clinically relevant; disease classification; imaging modality; improved; improved outcome; longitudinal, prospective study; magnetic resonance imaging biomarker; mortality; mortality risk; novel; outcome prediction; patient population; personalized risk prediction; radiomics; repaired; response; risk stratification; targeted treatment

Project Summary Functional mitral regurgitation (FMR) portends a bleak prognosis and is a common consequence of ischemic and non-ischemic cardiomyopathy (ICM, NICM), where adverse annular and left ventricular (LV) remodeling and/or infarction alters mitral valve (MV) function. Prior studies demonstrate significant increases in mortality risk as severity of FMR increases; mortality rates range from 15-40% at 1 year. Furthermore, as the prevalence of heart failure (HF) is rising, FMR is projected to double from over 2 million patients in 2000 to over 4 million patients in the United States by 2030. Defining FMR severity, optimal timing of intervention, and most appropriate method for intervention remain controversial. Recently, MITRA-FR and COAPT trials demonstrated contrasting survival benefit with percutaneous MV repair, demonstrating the importance and need for more optimal selection criteria. Currently, the patient selection criteria for Mitraclip therapy are solely based on MV anatomy and controversial echocardiographic criteria for FMR severity. Cardiac magnetic resonance (CMR) provides an exciting opportunity to address numerous unmet needs regarding characterizing FMR and the need for more optimal selection criteria for improving outcomes. Superior accuracy and reproducibility for quantification of LV size and function, and gold standard tissue characterization, positions CMR as the ideal imaging modality for comprehensively characterizing FMR and the underlying myopathic processes that significantly impact response to FMR therapies. The goal of the current research is to develop personalized risk prediction for FMR patients through explainable unsupervised phenomapping enriched with advanced CMR imaging biomarkers, and to determine the CMR predictors of reverse remodeling following modern therapies for FMR.

项目摘要 功能性二尖瓣返流(FMR)预示着黯淡的预后，是一种常见的 缺血性和非缺血性心肌病(ICM、NICM)的后果，在不利的情况下 二尖瓣环和左心室(LV)重构和/或梗塞改变了二尖瓣(MV)功能。 先前的研究表明，随着FMR严重程度的增加，死亡风险显著增加； 1年内死亡率为15%-40%。此外，由于心力衰竭的流行率 (HF)正在上升，预计FMR将从2000年的200多万人增加一倍，达到400多万人 到2030年，美国将有更多的患者。定义FMR严重性、最佳干预时间，以及 最合适的干预方法仍然存在争议。最近，Mitra-FR和 COAPT试验表明，与经皮MV修复相比， 论证了更优化的选择标准的重要性和必要性。目前，患者 MitraClip疗法的选择标准完全基于MV解剖，且存在争议 FMR严重程度的超声心动图标准。心脏磁共振(CMR)提供了一种 提供令人兴奋的机会来解决有关FMR的特征和需求方面的许多未满足的需求 以获得更优化的选择标准，以改善结果。卓越的准确性和重复性 左心室大小和功能的量化，以及黄金标准的组织特征，将CMR定位为 综合表征FMR和潜在肌病的理想成像方式 对FMR疗法的反应有显著影响的过程。目前研究的目标是 通过可解释的无监督方式开发FMR患者的个性化风险预测 用先进的CMR成像生物标记物丰富的表观映射，并确定CMR 现代治疗后FMR逆转重塑的预测因素。