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。 作为一种社会成本负担，到2030年，心力衰竭护理将接近1600亿美元。虽然应急策略 冠状动脉血流重建已大幅提高死亡率，发病率居高不下。矛盾的是， 成功的再灌注可能会导致意外的微血管损伤，并随后导致心肌内损伤 大出血。在40-50%的ST段抬高心肌梗死患者中，心肌内出血可以 发生，导致对心肌微结构的不利影响。显著的结构-功能后果 包括持续性心功能不全、致命性心律失常和心力衰竭。在众多成像生物标记物中， 心肌内出血和左心室射血分数(心功能的标志)有 对包括心力衰竭在内的不良心血管结局的最强预测价值。心脏磁共振 (CMR)具有较高的空间分辨率，是表征脑梗塞后病变的首选检查方法 心肌组织异质性。然而，目前的CMR方法缺乏对心肌出血的检测 敏感性和特异性，而同时检测心肌出血和提供心脏 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、全心的 电影CMR框架，使用纯血管内示踪剂跟踪和空间标定急性心肌梗死 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 在猪模型和出血性急性心肌梗死患者中，通过从大量和多样化的患者池中抽样。我们会 集成高质量、多尺度、多维数据，为患者构建适应疾病的模型 预测急性心肌梗死后的不良重构和心力衰竭。我们希望我们提出的方法能够刺激 治疗出血转化的治疗创新作为治疗出血的补充途径 缓解下游心力衰竭。例子可能包括控制性再灌注或辅助治疗。 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到 血红蛋白降解代谢物早期同步描述心肌内出血和 心功能的量化。我们的发现将为患者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，以改善心力衰竭结果。

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.