Myocardial Tissue Characterization with MR Relaxometry in Heart Failure

项目摘要 心力衰竭（HF）已成为心血管医学当前面临的最大挑战。 亚临床心功能不全的检测可以给我们一个独特的机会，治疗患者在一个 疾病的早期阶段，并修改风险因素，以预防或减缓HF的发展， 进展在扩张型非缺血性心肌病（NICM）的HF中，细胞外基质的早期变化， 基质体积（ECV）和心肌纤维化和炎症的形成导致心肌纤维化的损害。 心室功能和心律失常的沉淀。因此，这些变化的早期检测可以 具有显著的临床影响。心血管磁共振（CMR）是一种非侵入性， 多方面的，强大的成像模式，不采用电离辐射，具有高空间分辨率， 分辨率和提供出色的软组织对比度。心肌T1和T2弛豫时间改变， 间质弥漫性纤维化和炎症的存在。当前CMR的一个主要局限性 该技术使用疾病状态半定量和主观评估。新进展， CMR允许弛豫时间的逐体素量化以表征心肌组织 组合物，类似于心肌区域活检，作为一种独特而强大的工具， 任何其他成像模式都无法比拟。我们最近开发了新的方法， 准确测量体内心肌T1和T2时间。在这项研究中，我们建议继续 我们的多层T1和T2的开发、改进和多中心/多供应商评估 映射序列同时，在一项初步临床研究中，我们将评估T1的预测价值， 新识别的扩张型NICM患者的T2和ECV，用于HF进展和不良心脏事件 2年临床随访期间的事件。我们还将评估CMR与非CMR的增量价值 HF进展和不良心脏事件的标志物。

Project Summary Heart failure (HF) has emerged as the greatest current challenge in cardiovascular medicine. Detection of subclinical cardiac dysfunction could give us a unique opportunity to treat patients at an earlier stage of disease and to modify the risk factors to prevent or slow HF development and progression. In HF with dilated non-ischemic cardiomyopathy (NICM), early changes in extracellular matrix volume (ECV) and formation of myocardial fibrosis and inflammation result in impairment of ventricle function and precipitation of arrhythmias. Therefore, early detection of these changes could have significant clinical impact. Cardiovascular magnetic resonance (CMR) is a non-invasive, multifaceted, powerful imaging modality that employs no ionization radiation, has high spatial resolution and provides excellent soft tissue contrast. Myocardial T1 and T2 relaxation times change in the presence of interstitial diffuse fibrosis and inflammation. A major limitation of current CMR technique is use of semi-quantitative and subjective assessment of disease status. Novel advances in CMR allow voxel-wise quantification of relaxation times to characterize myocardial tissue composition, analogous to myocardial regional biopsy, as a unique and powerful tool which is unparalleled by any other imaging modality. We have recently developed novel approaches to accurately measure in-vivo myocardial T1 and T2 times. In this study, we propose to continue development, refinement and multi-center/multi-vendor evaluation of our multi-slice T1 and T2 mapping sequences. Concurrently, in a pilot clinical study, we will assess the predictive value of T1, T2 and ECV in patients with newly recognized dilated NICM for HF progression and adverse cardiac events over a 2-year clinical follow up. We will also assess incremental value of CMR vs. non-CMR markers of HF progression and adverse cardiac events.