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: 8070470
• 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/8070470
• 关键词: Accounting; Acute; Admission activity; Affect; Cardiac; Cardiomyopathies; Clinical; Clinical Trials; Coupled; Data; Databases; Development; Diagnosis; Direct Costs; Echocardiography; Electrocardiogram; Evaluation; FDA approved; Facilities and Administrative Costs; Foundations; Goals; Health; 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; 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（由申请人提供）：心力衰竭（HF）影响美国超过500万人，并且每年增加超过50万人。急性失代偿性HF占每年超过一百万的住院人数。估计2006年HF的直接和间接成本为296亿美元。我们的长期目标是通过更准确地预测心脏再灌注治疗（CRT）和/或血运重建的反应来改善HF患者的预后。CRT已被FDA批准用于治疗常规治疗无效的HF患者。然而，根据常规标准选择CRT的患者中有20 - 40%对CRT无反应。超声心动图已显示可改善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"真实世界"条件下，目前可用的超声心动图技术还不能用于常规预测CRT反应。我们的主要目标是预测心脏再同步治疗对HF引起的传导紊乱和心室不同步患者的反应。这将通过改进左心室（LV）不同步的诊断和表征来实现，使用我们的新型定量多谐波相位分析（MHPA）的ECG门控单光子发射计算机断层扫描（SPECT）心肌灌注成像（MPI）研究，并通过将LV不同步的评价整合到我们从同一研究中建立的心肌灌注和活力的量化。这种综合定量也将用于预测缺血性心肌病HF患者对血运重建的反应-我们的次要目标。我们建议通过ECG门控SPECT MPI测量LV不同步，因为1）它广泛可用，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HF患者管理所需的，无需任何额外的程序。具体而言，在本研究中，我们将1）开发LV不同步模拟工具，该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确定准确MHPA测量的成像要求对其进行优化，3）定义并验证描述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LV不同步量化结合我们建立的灌注/存活量化来预测HF患者对CRT的反应，和5）使用LV不同步、灌注和存活的综合量化来预测患有缺血性心肌病的HF患者对血运重建的反应。在完成这项研究后，我们将为我们的相位分析方法建立强大的科学基础，从而支持一项大型临床试验，以证明ECG门控SPECT MPI的有效性，我们对HF患者的LV不同步性、灌注和存活率进行了综合量化，并促进了临床的广泛应用。公共卫生相关性：心力衰竭影响美国超过500万人，并且每年增加超过50万人。急性失代偿性心力衰竭每年导致超过一百万人住院，2006年心力衰竭的直接和间接费用估计为296亿美元。本研究旨在为我们从常规ECG门控SPECT心肌灌注成像研究中综合定量左心室不同步性、灌注和存活性建立强有力的科学基础，以通过更准确地预测心力衰竭患者对心脏栓塞治疗和/或血运重建的反应来改善心力衰竭患者的预后。