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

• 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
• 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

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.

项目概要 急性心肌梗死（AMI）继发的心力衰竭仍然是死亡和残疾的主要原因。 作为社会成本负担，到 2030 年，心力衰竭护理费用将接近 1600 亿美元。 重新建立冠脉血流已大幅改善死亡率，但发病率仍然很高。自相矛盾的是， 成功的再灌注可能会导致意外的微血管损伤以及随后的心肌内损伤 出血。 40-50%的ST段抬高型心肌梗死患者可出现心肌内出血 的发生，从而对心肌微结构产生不良影响。显着的结构-功能后果 包括持续性心功能障碍、致命性心律失常和心力衰竭。在一系列成像生物标志物中， 心肌内出血和左心室射血分数（心脏功能的标志）具有 对不良心血管结局（包括心力衰竭）的最强预测价值。心脏磁共振 (CMR) 提供高空间分辨率，是梗塞后表征的首选方式 心肌组织异质性。然而，目前检测心肌出血的 CMR 方法缺乏 敏感性和特异性，而同时检测心肌出血并提供心脏信息的方法 缺乏单次快速扫描的功能评估。我们建议开发一种快速、自由呼吸、全心全意的呼吸系统。 电影 CMR 框架采用纯血管内示踪剂来跟踪和空间标定急性心肌病 出血，同时提供有关心脏功能的信息。我们将严格测试我们的技术 通过从大量不同的患者库中取样，在猪模型和出血性 AMI 患者中进行研究。我们将 整合高质量、多尺度、多维度的数据，构建适应患者的疾病模型 AMI 后不良重塑和心力衰竭的预测。我们期望我们提出的方法能够刺激 出血性转化管理的治疗创新作为补充途径 减轻下游心力衰竭。例子可能包括控制再灌注或辅助治疗 干预措施。成功完成我们提议的工作将把重点从延迟检测转移 血红蛋白降解代谢物可早期同时描述心肌内出血和 心脏功能的量化。我们的研究结果将为患者的进一步发展奠定基础 基于结构-功能关系的自适应图像引导方法可改善心力衰竭的结果。