Noninvasive assessment of coronary endothelial function by multi-slice MRI

多层MRI无创评估冠状动脉内皮功能

• 批准号: 10617836
• 负责人: Michael Schaer
• 金额: $ 24.56万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-01 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10617836
• 关键词: 3-Dimensional; Acute Coronary Event; Anatomy; Area; Arteries; Attenuated; Award; Blood Vessels; Blood flow; Calibration; Cardiac; Cardiac Catheterization Procedures; Cardiovascular system; Catheterization; Cessation of life; Characteristics; Cine Magnetic Resonance Imaging; Clinical; Coronary; Coronary Arteriosclerosis; Coronary artery; Detection; Development; Diagnostic; Dilatation - action; Disease; Disease Progression; Endothelial Cells; Endothelium; Event; Exercise; Exhibits; Fatty acid glycerol esters; Freezing; Functional disorder; Future; Health; Heart; Heterogeneity; Image; Imaging Techniques; Impairment; Intervention; Isometric Exercise; Knowledge; Life; Location; Magnetic Resonance; Magnetic Resonance Imaging; Measurement; Measures; Mediating; Medical; Methods; Monitor; Myocardial Infarction; Nitric Oxide; Noise; Participant; Patients; Pericardial body location; Persons; Physiologic pulse; Physiology; Population; Reproducibility; Resolution; Rest; Risk; Rupture; Sample Size; Signal Transduction; Slice; Stenosis; Stress; Testing; Thick; Thinness; Time; Tissues; United States; Validation; Water; Work; anatomic imaging; clinical imaging; clinical practice; clinically relevant; constriction; data acquisition; design; disability; endothelial dysfunction; heart motion; in vivo; non-invasive imaging; novel; novel strategies; premature; prognostic; response; stressor; tool; treatment response; two-dimensional

Coronary artery disease (CAD) remains a leading and important cause of disability and premature death in the United States. Conventional clinical imaging characterizes coronary artery anatomy, but because most acute coronary events result from plaque rupture in regions previously exhibiting less than 50% luminal stenosis, current state-of-the-art anatomic imaging cannot predict where plaque progression and events will occur. A new approach is needed and evidence suggests that coronary endothelial function (CEF) imaging can fill this gap. CEF is considered a “barometer” of vascular health because endothelial release of nitric oxide in response to certain stressors is a defining characteristic of healthy vascular tissue that results in arterial dilatation and increased blood flow. Impaired endothelial nitric oxide release, or endothelial dysfunction, is a marker for sub-clinical disease, an independent predictor of future CAD progression and cardiac events, and responds favorably to beneficial medical interventions. Despite the well-established diagnostic and prognostic importance of CEF, it is rarely measured in clinical practice because it was mostly measured with invasive cardiac catheterization. We recently developed a noninvasive magnetic resonance imaging (MRI) means to quantify local CEF that combines 2-dimensional (2D) cine MRI with isometric handgrip exercise (IHE). The main limitation is that the 2D approach only allows CEF measurements at just two to four locations and therefore cannot characterize CEF in multiple arteries or regional heterogeneity present throughout a diseased coronary artery. The aims of our proposal are 1) to develop a new multi-slice MRI method that to assess CEF area changes along proximal to mid segments in all major coronary arteries; 2) to optimize and validate the proposed method’s ability to measure cross sectional areas by assessing both accuracy and precision; and 3) to validate the CEF measures from the proposed method against the noninvasive gold-standard including reproducibility testing in both healthy subjects and stable CAD patients. This work will provide a robust, noninvasive means to better and more comprehensively assess CEF, an independent predictor of future atherosclerotic progression and events, and barometer of response to therapy. Knowledge of accuracy, precision, and reproducibility values will enable us to design future studies investigating novel interventions and monitoring disease progression.

冠状动脉疾病（CAD）仍然是残疾和过早死亡的主要和重要原因 美国。常规的临床成像特征冠状动脉解剖学，但由于大多数急性 冠状动脉事件是由以前表现出少于50％腔狭窄的地区的斑块破裂引起的， 当前的最新解剖成像无法预测牙菌斑的进展和事件的发生。一个 需要新的方法，证据表明冠状动脉内皮功能（CEF）成像可以填补这一点 差距。 CEF被认为是血管健康的“晴雨表”，因为一氧化氮在 对某些应激源的反应是健康血管组织的定义特征，导致动脉 扩张和血流增加。内皮一氧化氮释放或内皮功能障碍受损是一个 亚临床疾病的标记，这是未来CAD进展和心脏事件的独立预测指标，以及 对有益的医疗干预措施有利的回应。尽管诊断和预后良好 CEF的重要性，很少在临床实践中测量，因为它主要是用侵入性测量的 心脏导管插入术。我们最近开发了无创磁共振成像（MRI）的均值 量化将二维（2D）Cine MRI与等距手工夹（IHE）相结合的局部CEF。这 主要限制是2D方法仅允许仅在两个到四个位置进行CEF测量 因此，无法在整个犹豫不决的多个动脉或区域异质性中表征CEF 冠状动脉。我们提案的目的是1）开发一种新的多切片MRI方法，以评估CEF 所有主要冠状动脉的区域变化沿近端到中段； 2）优化和验证 提出的方法通过评估准确性和精度来测量横截面区域的能力； 3） 通过提出的方法验证CEF措施，以针对非侵入性金标准 健康受试者和稳定的CAD患者的可重复性测试。这项工作将提供强大的 非侵入性手段更好，更全面地评估CEF，这是对未来的独立预测指标 动脉粥样硬化进展和事件，以及对治疗的反应晴雨表。准确性的知识 精度和可重复性值将使我们能够设计未来研究新干预措施的研究 并监测疾病进展。