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Implications of Intra-Myocardial Fat Deposition upon Propensity for Malignant Arrhythmia

心肌内脂肪沉积对恶性心律失常倾向的影响

基本信息

批准号：
10249267
负责人：
Saman Nazarian
金额：
$ 61.1万
依托单位：
UNIVERSITY OF PENNSYLVANIA
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-08-10 至 2024-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10249267
关键词：
Ablation Adult Arrhythmia Biometry Blood Vessels Cardiac ablation Cardiomyopathies Chronic Cicatrix Cohort Studies Complication Computer Simulation Data Defibrillators Deposition Diagnostic Electrophysiology (science)Epidemiology Event Exhibits Fatty acid glycerol esters Fiber Gadolinium Geometry Heart Image Implant Individual Differences Infarction Institution Knowledge Life Linear Regressions Location Magnetic Resonance Imaging Maintenance Malignant - descriptor Metabolic Metaplasia Modeling Myocardial Myocardial Infarction Myocardial perfusion Myocardium National Heart, Lung, and Blood Institute Participant Patient imaging Patients Pennsylvania Performance Pharmaceutical Preparations Physiological Population Prevalence Procedures Property Refractory Reporting Research Research Personnel Rest Role Safety Sinus Site Universities Ventricular Tachycardia X-Ray Computed Tomography base detector experience implantation improved insight ischemic cardiomyopathy medical schools patient population predictive modeling prospective response simulation treatment response

项目摘要

Life-threatening ventricular tachycardia (VT) remains a major complication of myocardial infarction. Catheter ablation aims to destroy the VT substrate, diseased myocardium that slows local conduction sufficiently to perpetuate circuit reentry. The current understanding of the VT substrate revolves around the interaction of surviving strands of viable myocardium primarily at the periphery of infarct scar. Our preliminary data, however, suggests that critical VT circuit sites are viable myocardial strands that reside in the scar core, and are often surrounded by intra-myocardial fat deposition. Intra-myocardial fat is not a simple bystander; it is metabolically active and vascular, an effective insulator of conductive fibers, and modulates local conduction properties. This proposal will investigate the mechanistic consequence of intra-myocardial fat deposition upon impulse conduction and the propensity to sustain VT in adults with prior myocardial infarction. We propose to use MRI and CT images of patients with post-infarct VT to 1) to define the prevalence and distribution of myocardial fat deposition in patients with prior infarction and VT, 2) to characterize the conduction and repolarization properties of viable channels within scar based upon proximity to myocardial fat, 3) to examine the association of VT circuit sites with proximity to myocardial fat, and 4) to dissect the contribution of myocardial fat to VT events using patient-specific models, and to evaluate the diagnostic performance of model-predicted optimal ablation sites with and without inclusion of myocardial fat. Our group has extensive experience with MRI safety and image optimization in defibrillator recipients. Additionally, we have assembled a team of experts in image acquisition and analysis, epidemiology, biostatistics, simulations, and VT management. The findings of this study will have wide applicability to our mechanistic understanding and management of post-infarct VT.

危及生命的室性心动过速（VT）仍然是心肌梗死的主要并发症。导管