PFI-RP: Noninvasive Technology to Determine an Individual's Risk of Having a Heart Attack

创新研究伙伴关系（PFI-RP）项目的广泛影响/商业潜力是深远的。心血管疾病是世界范围内导致死亡的主要原因。近几十年来，虽然冠状动脉疾病（心脏病发作的原因）的治疗取得了重大进展，但心脏病发作和死亡人数仍在增加，主要原因是人口老龄化。国家为此付出的代价是惊人的，目前每年超过3000亿美元，而且还在增加。迫切需要更好和更具成本效益的诊断程序和治疗方案。本研究的目标是开发一种创新的、非侵入性的计算机分析程序，以精确评估个体患者心脏病发作的风险，并在软件产品原型中实现该程序。在成功完成研究后，工业合作伙伴致力于进行临床试验，FDA批准，将产品带入临床，并将其商业化。这项研究将改善冠状动脉疾病的诊断、预后和治疗，从而降低成本、风险和不必要的侵入性手术，同时产生更好的结果和生活质量。一个全面的传播、推广、以及博士和博士后的教育，这将进一步扩大项目的影响。拟议的项目将解决心血管疾病中一个潜在的、迄今尚未解决的问题，即所谓的易损斑块。这些是动脉壁上的脂质池，由一层薄的、发炎的纤维帽与管腔隔开，纤维帽破裂后将栓子释放到血流中，导致凝块形成并阻塞血流。易损斑块估计是大约三分之二的心脏病发作的原因，但到目前为止，它们的检测和组成只能通过侵入性手术来确定。最近的突破提供了从CT扫描中分割易损斑块的机会，并确定物质成分，包括脂质和钙含量，以及纤维帽，从中可以制定针对患者的计算模型。这些技术首次提供了无创分析和研究破裂前应力状态的机会，并在发生和未发生破裂的情况下进行破裂模拟。描述破裂概率的风险分层标准将从这些研究中确定，为医生提供治疗方案的指导，如支架植入、旁路移植、积极的药物治疗或标准的药物治疗，包括他汀类药物、抗高血压药物和生活方式的改变。该奖项反映了美国国家科学基金会的法定使命，并通过使用基金会的知识价值和更广泛的影响审查标准进行评估，被认为值得支持。

The broader impact/commercial potential of this Partnerships for Innovation-Research Partnerships (PFI-RP) project are far reaching. Cardiovascular disease is the leading cause of death worldwide. Although the treatment of coronary artery disease - the cause of heart attacks - has progressed significantly in recent decades, the number of heart attacks and deaths is increasing, due primarily to the aging population. The cost to the nation is staggering, presently over $300 billion per year, and increasing. Better and more cost-effective diagnostic procedures and treatment options are urgently needed. The objectives of this research are the development of an innovative, noninvasive, computer analysis procedure to precisely assess the risk of a heart attack occurring in an individual patient and the implementation of the procedure in a software product prototype. Upon successful completion of the research, the industrial partner is committed to pursuing clinical trials, FDA approval, bringing the product to the clinic, and commercializing it. This research will improve the diagnosis, prognosis, and treatment of coronary artery disease, thereby reducing cost, risk, unnecessary invasive procedures and, at the same time, producing better outcomes and quality of life. A comprehensive program of dissemination, outreach, and education of PhD and post-doctoral students is proposed that will further broaden the impacts of the project. The proposed project will address an insidious and heretofore unsolved problem in cardiovascular disease, so-called vulnerable plaques. These are lipid pools in the wall of an artery, separated from the lumen by a thin, inflamed, fibrous cap, which upon rupture releases emboli into the blood stream, causing clot formation and blocking flow. Vulnerable plaques are estimated to be the cause of approximately two-thirds of heart attacks, but heretofore their detection and composition could only be determined by invasive procedures. Recent breakthroughs have presented the opportunity to segment vulnerable plaques from CT scans, and identify material constituents, including lipid and calcium content, and fibrous caps, from which patient-specific, computational models can be formulated. These provide, for the first time, the opportunity to noninvasively analyze and study stress states prior to rupture and to perform rupture simulations under circumstances that have, and have not, led to rupture. Risk stratification criteria describing the probability of rupture will be determined from these studies to provide physicians with guidelines for treatment protocols, such as stenting, bypass grafting, aggressive medical therapy, or standard medical therapy including statins, antihypertensives, and lifestyle modifications.This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.