Real-time Wideband Cardiac MRI for Patients with a Cardiac Implantable Electronic Device

项目总结/摘要：出于未满足的需求，以提高我们的心脏成像价值， 该提案旨在提高心血管系统的质量并扩大其适用性。 植入心脏植入式电子器械（CIED）患者的MR（CMR）。CMR如果成功， 在CIED患者中比其他心脏成像方式（SPECT，超声心动图）更有价值，因为 有潜在的结构性心脏病，通常需要复杂的下游临床决策（新的或 症状恶化、室性心动过速消融、电池更换、CRT升级）。作为一种多功能模态，CMR 能够综合评价包括心室功能、灌注、瘢痕和瓣膜血流。 在诊断之外，CMR已被证明可以预测缺血性心脏病和非缺血性心脏病患者的主要不良心脏事件（MACE）。 和非缺血性心肌病患者，并为电生理程序提供指导。 不幸的是，由于CIED和心律失常以及呼吸不良引起的临床显著图像伪影- 在成像期间，超过300万患有CIED的美国人可能无法从标准CMR中受益。 为了弥合心脏成像中的这一差距，我们建议协同应用两种先进的CMR技术：（1） 能够抑制由CIEDs引起的图像伪影的宽带脉冲序列，以及（2） 压缩感知（CS）加速的实时序列，能够实现对 心律失常和呼吸运动，降低比吸收率。科学的前提是支持 我们在开发和翻译宽带和CS CMR序列方面的经验（>9年）。通过利用 我们在CS中的资源由R 01 HL 138578和R21 EB 024315支持，我们已经组装了一套独特的CS- 加速的实时宽带CMR脉冲序列以及内联图像重建方法， 用CIED给病人成像综合实时宽带应力CMR联合评估 心室功能、灌注、瓣膜功能和瘢痕，用于评估新发或恶化的心血管疾病 症状将使医疗费用减少47%（1185.67美元的医疗保险报销技术 和阅读费用），扫描时间（25分钟）减少88%， 负荷SPECT（$1544.80，3小时）和静息超声心动图（$707.96，25分钟）。对于附加值，疤痕 用CMR评估的负荷将有助于预测MACE和指导CIED患者的EP手术。 本研究的目的是：（1）评估实时宽带应力CMR的准确性和精度， CAD患者与模拟CIED植入，（2）确定实时宽带的预后价值 CIED患者的应力CMR，以及（3）验证实时宽带晚期钆增强CMR， CIED患者的电解剖标测。这项建议具有很高的影响潜力，因为拟议的真实的- 时间 测试 宽带巨磁共振技术将广泛适用于单一诊断/预后/预处理 对于越来越多的CIED患者，从而增加了心脏成像对该队列的价值。

Project Summary/Abstract: Motivated by an unmet need to increase the value of cardiac imaging in our healthcare system, this proposal seeks to improve the quality and expand the applicability of cardiovascular MR (CMR) for patients with a cardiac implantable electronic device (CIED). CMR, if successful, delivers better value than other cardiac imaging modalities (SPECT, echocardiography) in patients with a CIED because they have underlying structural heart disease and often require complex downstream clinical decisions (new or worsening symptoms, VT ablation, battery replacement, CRT upgrades). As a versatile modality, CMR is capable of a comprehensive evaluation including ventricular function, perfusion, scar, and valvular flow. Beyond diagnosis, CMR has been shown to predict major adverse cardiac events (MACE) in both ischemic and non-ischemic cardiomyopathy patients and to afford guidance for electrophysiologic procedures. Unfortunately, due to clinically significant image artifacts induced by CIEDs and arrhythmia and poor breath- holding during imaging, over 3 million Americans with a CIED may not benefit from a standard CMR. To bridge this gap in cardiac imaging, we propose to synergistically apply two advanced CMR technologies: (1) wideband pulse sequences that are capable of suppressing image artifacts induced by CIEDs and (2) compressed sensing (CS) accelerated real-time sequences that are capable of achieving insensitivity to arrhythmia and breathing motion and reducing specific absorption rate. The scientific premise is supported by our experiences (>9 years) in developing and translating wideband and CS CMR sequences. By leveraging our resources in CS supported by R01HL138578 & R21EB024315, we have assembled a unique suite of CS- accelerated real-time wideband CMR pulse sequences together with inline image reconstruction methods for imaging patients with a CIED. Comprehensive real-time wideband stress CMR combining evaluation of ventricular function, perfusion, valve function, and scar for assessing new or worsening cardiovascular symptoms will enable a 47% reduction in healthcare charges ($1185.67 Medicare reimbursement technical and reading fees) and 88% reduction in scan time (25 min) compared to current clinical practice combining stress SPECT ($1544.80, 3 hours) and resting echocardiography ($707.96, 25 min). For added value, scar burden assessed with CMR would be useful for predicting MACE and guiding EP procedures in CIED patients. The aims of this proposal are to: (1) evaluate the accuracy and precision of real-time wideband stress CMR in CAD patients with a simulated CIED implantation, (2) determine the prognostic value of real-time wideband stress CMR in CIED patients, and (3) validate real-time wideband late gadolinium enhanced CMR against electroanatomic mapping in CIED patients. This proposal has high impact potential because the proposed real- time test wideband CMR technology would be broadly applicable as a single diagnostic/prognostic/pre-procedural for a growing number of CIED patients, thereby increasing the value of cardiac imaging for this cohort.