Virtual cardiac electrophysiologic testing for sudden death risk stratification

用于猝死风险分层的虚拟心脏电生理测试

• 批准号: 7755353
• 负责人: Jason Ng
• 金额: $ 18.88万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-01-15 至 2011-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7755353
• 关键词: Arrhythmia; Cardiac; Cardiac ablation; Catheters; Cause of Death; Cells; Cessation of life; Characteristics; Cicatrix; Computer Simulation; Computer Workstations; Coronary Arteriosclerosis; Data; Data Sources; Defibrillators; Development; Devices; Electrophysiology (science); Evaluation; Event; External Defibrillator; Goals; Heart; Heart Arrest; Hospitals; Image; Implant; Infarction; Left ventricular structure; Life; Magnetic Resonance Imaging; Measures; Medical; Methods; Modeling; Morphology; Myocardial Infarction; Myocardium; Patients; Physiological; Predisposition; Prevention; Procedures; Property; Reading; Resuscitation; Risk; Science; Sensitivity and Specificity; Simulate; Site; Software Tools; Staging; Stratification; Sudden Death; System; Tachyarrhythmias; Techniques; Testing; Tissue Viability; Tissues; Training; United States; Ventricular; Ventricular Arrhythmia; Ventricular Fibrillation; Ventricular Tachycardia; base; clinical application; cohort; computer program; experience; healthy volunteer; heart electrical activity; high risk; improved; mortality; novel; prevent; programs; public health relevance; sudden cardiac death; three-dimensional modeling; tool; user-friendly; virtual

DESCRIPTION (provided by applicant): Sudden cardiac death is a leading cause of death in the United States. Although implanted cardioverter defibrillators (ICD) have been shown to be effective in preventing sudden cardiac death in patients who experience ventricular arrhythmias, current risk stratification methods in determining who will or will not benefit from an ICD have been suboptimal. In this application, the development and evaluation of a novel risk stratification tool to predict sudden cardiac death in patients who have had a myocardial infarction (i.e. heart attack) is proposed. This method is based on electrophysiologic testing; a risk stratification approach in which programmed stimulation via catheters placed in the ventricle is used to test for inducibility of potentially life threatening ventricular tachyarrhythmias. We hypothesize that computer simulations could be used to non- invasively test for inducibility of these ventricular tachyarrhythmias. It has been shown that the scars and partially viable tissue resulting from an infarction provide the substrate for these ventricular arrhythmias to occur. Contrast-enhanced magnetic resonance imaging (MRI) can effectively differentiate between viable myocardium, partially viable myocardium, and infarction scar. By assigning realistic electrophysiologic characteristics and conduction properties to the three-dimensional MRI image that is imported to the workstation, it is hypothesized that simulated programmed stimulation using this model will identify the patients who have inducible ventricular tachyarrhythmias and thus would benefit from an ICD. The integration of electrophysiologic computer modeling and cardiac MRI may have other potential clinical applications beyond sudden death risk stratification, including the evaluation of electrical dyssynchrony in candidates for bi- ventricular pacing therapy, pre-procedure planning for catheter ablation of patients with documented ventricular tachycardias, and as an educational software tool for training doctors and medical professionals. In the first stage of this study we plan to develop and implement of the tool using MRI data from healthy volunteers and patients undergoing electrophysiology testing to adjust model parameters. In the second stage, we will focus on comparing the results of "virtual" electrophysiologic testing to actual electrophysiologic testing in a larger cohort of patients and evaluating its ability to predict risk for ventricular arrhythmias. PUBLIC HEALTH RELEVANCE Effective risk stratification for sudden cardiac death is necessary for timely and appropriate therapy. A non- invasive approach to detect whether a patient has the necessary substrate for arrhythmias could significantly improve the prevention of sudden cardiac death, a leading cause of mortality in the United States.

描述（由申请人提供）：心源性猝死是美国的主要死因。尽管植入式心律转复除颤器（ICD）已被证明可有效预防室性心律失常患者的心源性猝死，但目前确定谁将或不会从ICD中受益的风险分层方法并不理想。在本申请中，提出了一种新的风险分层工具的开发和评价，以预测患有心肌梗死（即心脏病发作）的患者的心脏性猝死。该方法基于电生理学测试;一种风险分层方法，其中通过放置在心室中的导管进行程控刺激，用于测试潜在危及生命的室性快速性心律失常的诱导。我们假设计算机模拟可用于无创性检测这些室性快速性心律失常的诱导。研究表明，梗塞后形成的瘢痕和部分存活组织为室性心律失常的发生提供了基础。对比增强磁共振成像（MRI）可以有效区分存活心肌、部分存活心肌和梗死瘢痕。通过将真实的电生理特征和传导特性分配给导入工作站的三维MRI图像，假设使用该模型的模拟程控刺激将识别患有可诱导室性快速性心律失常的患者，从而从ICD中受益。电生理计算机建模和心脏MRI的集成可能具有除猝死风险分层之外的其他潜在临床应用，包括评价双心室起搏治疗候选人的电不同步性、记录室性心动过速患者导管消融术的术前计划以及作为培训医生和医疗专业人员的教育软件工具。在本研究的第一阶段，我们计划使用来自健康志愿者和接受电生理测试的患者的MRI数据来开发和实施该工具，以调整模型参数。在第二阶段，我们将重点比较“虚拟”电生理测试的结果，以实际的电生理测试在一个更大的患者队列，并评估其预测室性心律失常的风险的能力。公共卫生相关性心源性猝死的有效风险分层对于及时和适当的治疗是必要的。一种非侵入性的方法来检测患者是否有心律失常的必要基质，可以显着改善对心脏性猝死的预防，心脏性猝死是美国死亡的主要原因。