Cardiac MRI for Reperfusion Spatial Mapping to Improve Heart Failure Outcomes

项目摘要 继发于急性心肌梗死（AMI）的心力衰竭仍然是导致死亡和残疾的主要原因。 作为社会成本负担，到2030年心力衰竭护理将接近1600亿美元。虽然紧急战略 重建冠状动脉血流的方法大大改善了死亡率，但发病率仍然很高。巧合的是， 成功的再灌注可能导致意外的微血管损伤， 出血在40 - 50%的ST段抬高型心肌梗死患者中， 发生，导致对心肌微观结构的不利影响。显著的结构-功能后果 包括持续性心脏功能障碍、致命性心律失常和心力衰竭。在成像生物标志物的种类中， 心肌内出血和左心室射血分数（心功能的标志物）具有 对不良心血管结局（包括心力衰竭）的预测价值最强。心脏磁共振 (CMR)提供了高空间分辨率，是表征梗死后病变的首选方式。 心肌组织异质性然而，目前CMR检测心肌出血的方法缺乏 而同时检测心肌出血并提供心脏功能的方法， 缺乏单一快速扫描中的功能评估。我们建议培养一个快速，自由呼吸，全心 采用纯血管内示踪剂跟踪和空间标定急性心肌梗死的电影CMR框架 出血，同时提供有关心脏功能的信息。我们会严格测试我们的技术 在猪模型和出血性AMI患者中，通过从大量不同的患者库中取样。我们将 整合高质量、多尺度、多维数据，构建患者适应性疾病模型， 预测AMI后不良重构和心力衰竭。我们希望我们提出的方法能刺激 治疗出血性转化的治疗创新，作为 减轻下游心力衰竭。实例可以包括在治疗期间的受控再灌注或连续治疗。 干预措施。成功完成我们拟议的工作将把重点从延迟发现 血红蛋白降解代谢物对早期同时描述心肌内出血和 心脏功能的量化。我们的发现将为病人的进一步发展提供基础- 基于结构-功能关系的自适应图像引导方法，以改善心力衰竭结局。

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.