Development of MR-derived parameters of LV diastolic function: Validation and Comparison to LV and LA fibrosis

项目摘要 这一提议的临床影响是心脏磁共振评估舒张期功能的方法的发展。 以及确定它与左心室和左心房纤维化的关系。我们要检验的假设是 现有的心室和心房纤维化(弥漫性纤维化)可能反映在心房压力升高，或其他 心腔顺应性的舒张期参数，可以使用这些新方法来评估。我们也 假设舒张期参数和LV和LA弥漫性纤维化将是独立的重要预测因素 新发房颤。有大量证据表明，心房纤维化、心力衰竭伴保留EF，以及新的 发作性房颤是一个星座，彼此之间有很强的关联性，并且与舒张期功能障碍密切相关。这个 用于测量舒张期功能的工具的开发将对患者护理产生巨大的影响。 这项建议的目标是开发一种易于处理电影图像的方法来产生e‘，即 二尖瓣组织区域舒张期早期血流速度的特征跟踪方法。此外，目标是 是开发和测试简单而可靠的二尖瓣血流E和A测量方法 并开发测量肺静脉流量的方法。验证将在正常情况下进行 受试者，然后是110名患者。重现性将包括在内。 这项资助的创新是认识到舒张期功能是关键的--与 最近发展起来的用核磁共振和左房测量左心室弥漫性纤维化的能力 容量、张力和纤维化--对舒张期和左房内压关系的理解 心房重塑。我们进一步提出了创新的磁共振方法，包括黑血电影方法，它将 生成电影图像以更清晰地显示瓣膜，并可能有进一步的应用。我们建议 使用已经建立的具有相位对比度的切片跟踪，但将其与特征相结合- 追踪以极大地提高其临床可行性。 我们已经组建了一个团队，其中包括一支核磁共振物理学家，他们拥有新颖的收购和 重建，非侵入性心脏病专家和一名将指导翻译研究的放射科医生，以及多名 是疾病动物模型方面的专家，专门研究磁共振测量舒张压的方法 具有侵入性压力测量功能。PI是左房评价领域的先驱， 哪种舒张期功能是主要影响因素。为了实现这些目标，我们将共同努力，制定一项新的 评价舒张期功能参数E、A、E‘及更多的方法，并确定它们在 房颤的发展。

Project Summary The clinical impact of this proposal is the development of cardiac MR methods for evaluating diastolic function and determining how it relates to left ventricular and left atrial fibrosis. We will test the hypothesis is that pre- existing ventricular and atrial fibrosis (diffuse fibrosis) may be reflected in increased atrial pressures, or in other diastolic parameters of chamber compliance, which can be evaluated using these new methods. We also hypothesize that diastolic parameters and LV and LA diffuse fibrosis will be independent important predictors of new onset AF. There is a wealth of evidence that atrial fibrosis, heart-failure with preserved EF, and new onset AF are a constellation all strongly associated with each other, and with diastolic dysfunction. The development of tools for measuring diastolic function will have enormous impact in patient care. The goals of this proposal are to develop a method for easily processing cine images to yield e', the early diastolic velocity of the mitral valvular tissue region, using feature tracking methods. Further, the goals are to develop and test methods for simple and robust E and A measurements of blood flow through the mitral valve, and to develop methods for measuring pulmonary vein inflow. The validations will proceed in healthy subjects and then 110 patients. The reproducibility will be included. The innovation of this grant is the recognition that diastolic function is critical-- in conjunction with the recently developed capabilities of measuring left ventricular diffuse fibrosis with and MRI, and left atrial volumes, strain, and fibrosis-- in understanding the relationship between atrial pressure during diastole and left atrial remodeling. We further propose innovative MR methods, including a black blood cine method, which will generate cine images to visualize the valves more clearly, and might have further applications. We propose the use of slice-following with phase-contrast, which is already established, but will combine it with feature- tracking to vastly improve its clinical feasibility. We have assembled a team including an MRI Physicists with expertise in novel acquisition and reconstruction, non-invasive cardiologists and a radiologist who will guide the translational studies, and a multi- modality cardiologist who is expert in animal models of disease, for correlating MR measurements of diastolic function with invasive pressure measurements. The PI is a pioneer in the area of left atrial evaluation, for which diastolic function is a major influence. Together, working on these Aims, we will develop a new approaches for evaluating diastolic functional parameters, E, A, e' and more, and define their role in development of atrial fibrillation.