Measuring Left Ventricular Dyssynchrony from ECG-gated Myocardial Perfusion SPECT

通过心电门控心肌灌注 SPECT 测量左心室不同步

• 批准号: 7891234
• 负责人: Ji Chen
• 金额: $ 38.75万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-07-15 至 2013-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7891234
• 关键词: Accounting; Acute; Admission activity; Affect; Cardiac; Cardiomyopathies; Clinical; Clinical Trials; Coupled; Data; Databases; Development; Diagnosis; Echocardiography; Evaluation; FDA approved; Facilities and Administrative Costs; Foundations; Goals; Heart failure; Hospitals; Image; Left; Left ventricular structure; Measurement; Measures; Mechanics; Myocardial perfusion; Patient Selection; Patients; Perfusion; Phase; Procedures; Refractory; Relaxation; Research; Simulate; Software Tools; Techniques; United States; Ventricular; base; conventional therapy; digital; improved; indexing; novel; outcome forecast; public health relevance; response; simulation; single photon emission computed tomography; software development; tool

DESCRIPTION (provided by applicant): Heart failure (HF) affects more than 5 million people in the United States, and the number increases by more than 0.5 million every year. Acute decompensated HF accounts for over one million hospital admissions per year. The estimated direct and indirect cost for HF in 2006 is $29.6 billion. Our long-term objective is to improve the prognosis of HF patients by more accurately predicting their response to cardiac resynchronization therapy (CRT) and/or revascularization. CRT has been approved by FDA as a treatment of HF patient's refractory to conventional therapy. However, 20-40% of the patients who selected for CRT based on the conventional criteria do not respond to CRT. Echocardiography has shown to improve patient selection for CRT, but it requires expertise to obtain reliable results. The PROSPECT trial has shown that under "real-world" conditions the current available echocardiographic techniques are not ready for routine prediction of CRT response. Our primary goal is to predict the response to CRT in patients with HF-induced conduction disturbances and ventricular dyssynchrony. It will be accomplished by improved diagnosis and characterization of left ventricular (LV) dyssynchrony using our novel, quantitative multi-harmonic phase analysis (MHPA) of ECG-gated single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) study and by integrating this evaluation of LV dyssynchrony to our established quantification of myocardial perfusion and viability from the same study. This integrated quantification will also be used to predict the response to revascularization in HF patients with ischemic cardiomyopathy - our secondary goal. We propose to measure LV dyssynchrony from ECG-gated SPECT MPI, because 1) it is widely available, 2) it is highly reproducible, and 3) it can provide additional perfusion/viability information, which is needed for the management of the HF patient, without any additional procedure. Specifically, in this research we will 1) develop LV dyssynchrony simulation tools that can simulate gated SPECT MPI studies with a variety of LV dyssynchrony patters, 2) develop MHPA and optimize it by using the simulation tools to determine the imaging requirements for accurate MHPA measurements, 3) define and validate quantitative indices that describe LV dyssynchrony and development normal databases for these indices, 4) use the LV dyssynchrony quantification coupled with our established perfusion/viability quantification to predict the response to CRT in HF patients, and 5) use the integrated quantification of LV dyssynchrony, perfusion, and viability to predict the response to revascularization in HF patients with ischemic cardiomyopathy. Upon completion of this research, we will establish a strong scientific foundation for our phase analysis approach thus supporting a large clinical trial to prove the usefulness of ECG-gated SPECT MPI with our integrated quantification of LV dyssynchrony, perfusion, and viability in prognosis for HF patients and promoting widespread utilization clinically. PUBLIC HEALTH RELEVANCE: Heart failure affects more than 5 million people in the United States, and the number increases by more than 0.5 million every year. Acute decompensated heart failure accounts for over one million hospital admissions per year, and the estimated direct and indirect cost for heart failure in 2006 is $29.6 billion. This research is to establish a strong scientific foundation for our integrated quantification of left ventricular dyssynchrony, perfusion, and viability from the conventional ECG-gated SPECT myocardial perfusion imaging studies to improve the prognosis of heart failure patients by more accurately predicting their response to cardiac resynchronization therapy and/or revascularization.

描述（申请人提供）： 心力衰竭（HF）影响美国超过 500 万人，并且该数字每年以超过 50 万人的速度增加。每年因急性失代偿性心力衰竭住院的人数超过一百万。 2006 年 HF 的直接和间接成本估计为 296 亿美元。我们的长期目标是通过更准确地预测心力衰竭患者对心脏再同步治疗 (CRT) 和/或血运重建的反应来改善他们的预后。 CRT 已被 FDA 批准用于治疗常规治疗难治性心力衰竭患者。然而，根据常规标准选择 CRT 的患者中有 20-40% 对 CRT 没有反应。超声心动图已被证明可以改善 CRT 患者的选择，但需要专业知识才能获得可靠的结果。 PROSPECT 试验表明，在“现实世界”条件下，当前可用的超声心动图技术尚未准备好用于 CRT 反应的常规预测。我们的主要目标是预测心力衰竭引起的传导障碍和心室不同步患者对 CRT 的反应。它将通过使用我们新颖的心电门控单光子发射计算机断层扫描 (SPECT) 心肌灌注成像 (MPI) 研究的定量多谐波相位分析 (MHPA) 来改进左心室 (LV) 不同步的诊断和表征，并将左心室不同步的评估与我们既定的心肌灌注和活力量化相结合来实现。 同样的研究。这种综合量化还将用于预测缺血性心肌病心力衰竭患者对血运重建的反应——我们的次要目标。我们建议通过心电图门控 SPECT MPI 来测量左室不同步，因为 1) 它应用广泛，2) 它具有高度可重复性，3) 它可以提供额外的灌注/活力信息，这是心力衰竭患者管理所需的，无需任何额外的程序。具体来说，在这项研究中，我们将 1) 开发 LV 不同步模拟工具，可以模拟具有各种 LV 不同步模式的门控 SPECT MPI 研究，2) 开发 MHPA 并通过使用模拟工具来优化它，以确定精确 MHPA 测量的成像要求，3) 定义和验证描述 LV 不同步的定量指标，并为这些指标开发正常数据库， 4) 使用左心室不同步量化结合我们建立的灌注/活力量化来预测心力衰竭患者对 CRT 的反应，5) 使用左心室不同步、灌注和活力的综合量化来预测缺血性心肌病心力衰竭患者对血运重建的反应。这项研究完成后，我们将为我们的阶段分析方法奠定坚实的科学基础，从而支持大型临床试验，以证明心电图门控 SPECT MPI 的有用性，以及我们对 LV 不同步、灌注和心力衰竭患者预后的生存能力的综合量化，并促进临床广泛应用。公共卫生相关性：在美国，心力衰竭影响着超过 500 万人，并且该数字每年以超过 50 万人的速度增加。急性失代偿性心力衰竭每年导致超过 100 万人入院，2006 年心力衰竭的直接和间接费用估计为 296 亿美元。本研究旨在为传统心电门控 SPECT 心肌灌注成像研究中左心室不同步、灌注和活力的综合量化奠定坚实的科学基础，从而通过更准确地预测心脏再同步治疗和/或血运重建的反应来改善心力衰竭患者的预后。