CARDIAC MAGNETIC RESONANCE, CRT RESPONSE, OPTIMAL LEFT VENTRICULAR PACING SITE

心脏磁共振、CRT 反应、最佳左心室起搏部位

• 批准号: 8167198
• 负责人: Kenneth C Bilchick
• 金额: $ 2万
• 依托单位: UNIVERSITY OF VIRGINIA
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-03-01 至 2013-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8167198
• 关键词: Address; Affect; Cardiac; Cardiopulmonary; Cicatrix; Clinical; Clinical assessments; Computer Retrieval of Information on Scientific Projects Database; Data; Data Analyses; Echocardiography; Evaluation; Exercise stress test; Funding; Grant; Heart failure; Image; Institution; Lead; Left; Left ventricular structure; Logistic Regressions; Magnetic Resonance; Maps; Mechanics; Morbidity - disease rate; Myocardial; Patients; Physiologic pulse; Positioning Attribute; Procedures; Prospective Studies; Public Health; Research; Research Personnel; Resources; Site; Source; Statistical Methods; Survival Analysis; Testing; United States; United States National Institutes of Health; Universities; Ventricular; Virginia; Work; base; follow-up; indexing; mortality; novel; response; standard measure

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Heart failure is a major cause of morbidity/mortality and affects nearly 5 million people in the United States. Cardiac resynchronization therapy (CRT) has great potential clinical benefit for a number of these patients, but application is limited by difficulty identifying appropriate patients and technical limitations regarding left ventricular lead placement. This project applies a novel cardiac magnetic resonance (CMR) pulse sequence for strain known as cine DENSE (displacement encoding with stimulated echoes) to the evaluation of patients undergoing CRT. Of note, cine DENSE has been largely developed here at the University of Virginia and, as shown in the preliminary data, yields very high quality regional strain data even in patients with dilated and thinned left ventricles. In this study, we will test the hypothesis that CMR with DENSE assessment of circumferential mechanical dyssynchrony and scar imaging is significantly more accurate than echocardiography in predicting CRT response, with nonresponse the likely result when the left ventricular lead is positioned in or near significant scar. The specific aims are: 1) to assess the clinical use of CMR-based evaluation of mechanical dyssynchrony using cine DENSE for accurate prediction of CRT response, as measured by standard response indices; and 2) to establish the optimal relationship between left ventricular lead position and the underlying myocardial substrate using CMR scar imaging and three-dimensional scar maps. To address these aims, we are performing a prospective study with baseline clinical assessment, cardiac imaging, cardiopulmonary exercise testing, and neurohormonal assessment, followed by the clinical CRT procedure. These baseline assessments will then be repeated 6 months after CRT, with long-term 3-year follow-up. Statistical methods used in the data analysis will include Fisher's exact test, McNemar's test, logistic regression, and survival analysis. We believe the findings of this work will be of major public health importance to many patients with heart failure.

该子项目是利用该技术的众多研究子项目之一 资源由 NIH/NCRR 资助的中心拨款提供。子项目和 研究者 (PI) 可能已从 NIH 的另一个来源获得主要资金， 因此可以在其他 CRISP 条目中表示。列出的机构是 对于中心来说，它不一定是研究者的机构。 心力衰竭是发病/死亡的主要原因，影响着美国近 500 万人。 心脏再同步治疗（CRT）对许多此类患者具有巨大的潜在临床益处，但由于难以确定合适的患者以及左心室导线放置的技术限制，其应用受到限制。 该项目应用一种新型心脏磁共振 (CMR) 脉冲序列来评估接受 CRT 的患者，称为 cine DENSE（受激回声位移编码）。 值得注意的是，cine DENSE 很大程度上是在弗吉尼亚大学开发的，如初步数据所示，即使在左心室扩张和变薄的患者中，也能产生非常高质量的区域应变数据。 在本研究中，我们将检验以下假设：在预测 CRT 反应方面，CMR 结合周向机械不同步和疤痕成像的 DENSE 评估明显比超声心动图更准确，当左心室导线位于或靠近明显疤痕时，可能会导致无反应。 具体目标是： 1) 评估基于 CMR 的机械不同步评估的临床应用，使用 cine DENSE 准确预测 CRT 反应（通过标准反应指数测量）； 2) 使用 CMR 疤痕成像和三维疤痕图建立左心室导联位置和底层心肌基质之间的最佳关系。 为了实现这些目标，我们正在进行一项前瞻性研究，包括基线临床评估、心脏成像、心肺运动测试和神经激素评估，然后进行临床 CRT 程序。 这些基线评估将在 CRT 后 6 个月重复进行，并进行为期 3 年的长期随访。 数据分析中使用的统计方法包括 Fisher 精确检验、McNemar 检验、逻辑回归和生存分析。 我们相信这项工作的结果将对许多心力衰竭患者具有重大的公共卫生意义。