Comprehensive Assessment of Right Ventricular and Pulmonary Vascular Function via CT Imaging in Heart Failure Patients

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Project Summary Parent Award: Mechanical circulatory support is required by a large percentage of patients who undergo heart transplant and serves as a destination therapy for end-stage heart failure patients who are ineligible for transplant. However, clinicians are currently unable to predict the up to 40% of patients who develop right heart failure after receiving left ventricular assist devices. This project aims to use CT to obtain load-independent measures of ventricular function and ventricular-arterial coupling to improve prediction of right heart function and failure in patients receiving left ventricular assist devices. Supplement: This supplement extends the utility of the CT imaging proposed in the parent award and supports the training and development of a bioengineering graduate student. Recent work has enabled robust mapping of regional dysfunction via new CT-based quantitative metrics. Specifically, we have combined regional strain measured via CT (RSCT) with RV pressure waveforms to estimate regional myocardial work (MW) as the area of the pressure-strain loop (MWCT). However, the utility of MWCT as an indicator of RV dysfunction in TOF patients has not been established. Therefore, we propose to determine whether the amount of myocardium with impaired MWCT better predicts functional impairment than RSCT and volume measurements. This work not only aims to improve prognostic evaluation but could also yield mechanistic insights into why the RV is at risk of failing. Importantly, this work seamlessly builds on the data collection and analysis efforts already underway as part of the parent award. In addition to this new research direction, the supplement outlines tailored training for a promising PhD student already being mentored by the principal investigator. Together, they have developed a set of training activities which will enable her to thrive at the interface of cardiology, radiology, and bioengineering. Specifically, she has fostered a collaboration with a cardiologist who will provide opportunities for her to shadow clinical care of patients and take part in multidisciplinary patient discussions. In addition, she has identified conferences, journals, and supplemental coursework which will provide her the networking, publication, and training experiences she needs to continue her work in this translational field.