Novel Computational Methods for Detecting Early Right Ventricular Failure in the Tetralogy of Fallot Population

项目总结/摘要 法洛四联症是最常见的严重先天性心脏病。虽然手术改善了 预期寿命，残余肺动脉返流是常见的。肺动脉返流患者继续 出现运动不耐受、心力衰竭、心律失常和心源性猝死。肺动脉瓣 置换越来越多地用于预防右心室衰竭。我们对重塑的有限理解 右心功能不全妨碍了我们在早期发现细微的右心室功能障碍， 预防不可逆的心力衰竭。超声心动图指标在评估非常早期的 右心室衰竭的阶段。目前，我们选择肺动脉瓣介入治疗的患者是基于 在MRI上测量的右心室容积阈值。这种模式过于强调数量， 对心室功能影响太小。四联症早期右心衰竭缺乏准确的影像学指标 法洛是先天性心脏病专家面临的最大知识缺口之一。能够及早发现 在进展为不可逆性心力衰竭之前的心力衰竭将允许心脏病学家随访这些风险 患者更密切，并提供肺动脉瓣置换术宜早不宜迟。此外，能够 使用成像技术来识别早期右心衰竭的细微阶段可以帮助制药公司， 其他的医生科学家测试治疗反应。我假设创新的成像标记物 从计算评估的心脏MRI和超声心动图成像在高峰运动将 在预测法洛四联症患者早期右心室衰竭方面优于传统标记物。 本研究的目的是比较心脏血流和右心室的关系 法乐四联症患者的心功能，然后利用心功能的变化预测心力衰竭。 心室形状、应变和峰值运动时的收缩。通过完成这个项目，我将发现 心脏血流、右心室形态学改变和右心室收缩功能之间的关系 心室功能，这将弥补关于检测以下疾病的成像标记物的主要知识缺口： 法洛四联症人群中的早期和轻微右心衰竭。能够识别早期右心 失败将改变心脏病专家如何治疗法洛四联症患者的临床。我的长期目标是 医生科学家是成为一个学术心脏病专家，未来的初级教员和专家在正确的 成人先天性心脏病心力衰竭

Project Summary/Abstract Tetralogy of Fallot is the most prevalent severe congenital heart disease. Although surgery has led to improved life expectancy, residual pulmonary regurgitation is common. Patients with pulmonary regurgitation go on to develop exercise intolerance, heart failure, arrhythmias and sudden cardiac death. Pulmonary valve replacement is increasingly used to prevent right ventricular failure. Our limited understanding of remodeling of the right heart hampers our ability to detect subtle right ventricular dysfunction in the early stages and prevent irreversible heart failure. Echocardiographic metrics have poor sensitivity in assessing the very early stages of right ventricular failure. Currently we select patients for pulmonary valve intervention based on a right ventricular volume threshold measured on MRI. This paradigm places too much emphasis on volume and too little on ventricular function. The lack of precise imaging markers of early right heart failure in Tetralogy of Fallot is one of the largest gaps in knowledge facing congenital cardiologists. Being able to detect early right heart failure before progression to irreversible heart failure would allow cardiologists to follow these at-risk patients more closely and offer pulmonary valve replacements sooner rather than later. In addition, being able to use imaging to identify subtle stages of early right heart failure can help pharmaceutical companies and other physician-scientists test therapeutic response. I hypothesize that innovative imaging markers derived from computational assessments of cardiac MRI and echocardiographic imaging during peak exercise will outperform traditional markers in predicting early right ventricular failure in Tetralogy of Fallot patients. The goal of this study is to compare the relationship between cardiac flow and right ventricular function in Tetralogy of Fallot patients, and then predict heart failure using changes in ventricular shape, strain, and contraction at peak exercise. By completing this project, I will uncover key insights into the relationship among cardiac flow, morphologic changes of the right ventricle and right ventricular function which will bridge a major knowledge gap regarding imaging markers for the detection of early and subtle right heart failure in the Tetralogy of Fallot population. Being able to identify early right heart failure will change how cardiologists treat Tetralogy of Fallot patients clinically. My long-term goal as a physician-scientist is to become an academic cardiologist, future junior faculty member and expert in right heart failure in adults with congenital heart disease.