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Cardiac MRI for Reperfusion Spatial Mapping to Improve Heart Failure Outcomes

心脏 MRI 进行再灌注空间测绘以改善心力衰竭的预后

基本信息

批准号：
10717212
负责人：
Kim-Lien T Nguyen
金额：
$ 68.67万
依托单位：
UNIVERSITY OF CALIFORNIA LOS ANGELES
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-07-01 至 2028-04-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10717212
关键词：
Acceleration Acute Acute myocardial infarction Adverse effects Arrhythmia Biodegradation Biological Markers Blood Blood Vessels Blood capillaries Blood flow Breathing Cardiac Cardiovascular system Caring Cause of Death Cells Characteristics Clinical Compensation Coronary Data Detection Development Diagnosis Diagnostic Disease model Endowment Erythrocytes Evolution Extravasation Foundations Heart Heart failure Hemoglobin Hemorrhage Heterogeneity Histology Histopathology Hospitalization Hour Image Imaging Techniques Imaging technology Immune Infarction Intervention Intravenous Iron Left Ventricular Ejection Fraction Left Ventricular Remodeling Magnetic Resonance Maps Methods Modality Monitor Morbidity - disease rate Morphologic artifacts Motion Myocardial Myocardial Infarction Myocardial Reperfusion Myocardial dysfunction Myocardial tissue Myocardium Outcome Pathway interactions Patients Performance Pharmaceutical Preparations Predictive Value Prognostic Marker Protocols documentation Reperfusion Therapy Resolution Safety Sampling Scanning Secondary to Sensitivity and Specificity Severities Signal Transduction Slice Specificity Standardization Structure Structure-Activity Relationship T2 weighted imaging Techniques Testing Therapeutic Time Tracer Training Work adverse outcome cardiac magnetic resonance imaging disability ferumoxytol generative adversarial network heart function image guided image reconstruction imaging biomarker imaging detection imaging modality improved indexing individualized medicine innovation mortality multidimensional data porcine model predictive modeling prognostic value respiratory risk prediction risk stratification side effect societal costs spatiotemporal temporal measurement therapeutic target vascular injury

项目摘要

Project Summary Heart failure secondary to acute myocardial infarction (AMI) remains the leading cause of death and disability. As a societal cost burden, heart failure care will be nearing $160 billion by 2030. Although emergent strategies to re-establish coronary blood flow have substantially improved mortality, morbidity remains high. Paradoxically, successful reperfusion may contribute to unintended microvascular injury with subsequent intramyocardial hemorrhage. In 40-50% of patients with ST-elevation myocardial infarction, intramyocardial hemorrhage can occur, leading to adverse effects on the myocardial microstructure. Significant structure-function consequences include persistent cardiac dysfunction, fatal arrhythmias, and heart failure. Of the panoply of imaging biomarkers, intramyocardial hemorrhage and the left ventricular ejection fraction (a marker of cardiac function) have the strongest predictive value for poor cardiovascular outcomes including heart failure. Cardiac magnetic resonance (CMR) offers high spatial resolution and is the preferred modality for the characterization of post-infarct myocardial tissue heterogeneity. However, current CMR approaches to detect myocardial bleeding lack sensitivity and specificity whereas methods to simultaneously detect myocardial bleeding and provide cardiac function assessment in a single fast scan are lacking. We propose to develop a fast, free-breathing, whole-heart cine CMR framework that employs a pure intravascular tracer to track and spatially demarcate acute myocardial bleeding while simultaneously providing information about cardiac function. We will rigorously test our technique in swine models and patients with hemorrhagic AMI by sampling from a large and diverse patient pool. We will integrate high-quality, multiscale, multidimensional data to construct a patient-adaptive disease model for the prediction of post-AMI adverse remodeling and heart failure. We expect our proposed approach to spur therapeutic innovations for the management of hemorrhagic transformation as a complementary pathway for mitigating downstream heart failure. Examples may include controlled reperfusion or adjunctive therapy during interventions. Successful completion of our proposed work will shift the focus from delayed detection of hemoglobin degradation metabolites to early simultaneous depiction of intramyocardial hemorrhage and quantification of cardiac function. Our findings will provide a foundation for further development of a patient- adaptive, image-guided approach based on structure-function relationships to improve heart failure outcomes.

项目总结