CRT Lead Placement Planning using MRI

描述(由申请人提供)：使用双心室起搏器的心脏再同步治疗(CRT)是药物难治性心力衰竭患者的重要治疗选择，也是心室不同步的证据。然而，按照目前的选择标准和植入技术，接受CRT治疗的患者中有30%-40%对治疗没有反应。由于CRT具有侵入性，费用昂贵，具有显著的相关风险，并且需要终生需要起搏设备，因此显然需要更好的方法来优化治疗。多种因素影响患者对CRT的反应，包括糟糕的选择标准和/或非最佳的设备实施。在CRT实施中，左室起搏电极的位置对决定患者的反应有重要作用。该项目的总体目标是：1)开发一种基于MRI的方法，以计划和定位最新收缩区域的LV起搏导线；2)在一组接受CRT的患者身上测试该方法。 公共卫生相关性：我们建议开发一种方法，使用磁共振成像(MRI)来计划使用双心室起搏器接受心脏再同步治疗(CRT)的患者的左心室导联放置。该项目包括开发和验证用于通过MRI显示局部室壁不同步和心肌疤痕负荷的软件。然后，将在一系列患者中对基于MRI的方法进行评估，以测试其通过改善导线放置来改善预后的能力。

DESCRIPTION (provided by applicant): Cardiac resynchronization therapy (CRT) using a bi-ventricular pacemaker is an important treatment option for patients with drug-refractory heart failure and evidence of ventricular dyssynchrony. However, using current selection criteria and implantation techniques, 30-40% of patients undergoing CRT are non-responsive to the treatment. Because CRT is invasive, costly, has significant associated risks, and requires lifelong need of pacing device, there is a clear need for better methods to optimize the treatment. Multiple factors influence patient response to CRT including poor selection criteria and/or non-optimal device implementation. In the implementation of CRT, the position of the left ventricular (LV) pacing lead has a significant role in determining patient response. The overall goals of this project are: 1) to develop an MRI- based methodology to plan and locate the LV pacing lead in the area of latest contraction and 2) test the methodology on a group of patients undergoing CRT. PUBLIC HEALTH RELEVANCE: We propose to develop methodology to use magnetic resonance imaging (MRI) to plan left ventricular lead placement in patients undergoing cardiac resynchronization therapy (CRT) using a bi-ventricular pacemaker. The project involves development and validation of software for the display of regional ventricular dyssynchrony and myocardial scar burden by MRI. The MRI based methodology will then be evaluated in a series of patients to test its ability to improve outcomes by improving lead placement.