Improving Phenotypic Classification and Prediction of Treatment Outcomes in Patients with Non-ischemic Cardiomyopathy and Functional Mitral Regurgitation

项目摘要 功能性二尖瓣返流（FMR）预示着暗淡的预后， 缺血性和非缺血性心肌病（ICM，NICM）的后果，其中不良反应 环和左心室（LV）重塑和/或梗塞改变二尖瓣（MV）功能。 先前的研究表明，随着FMR严重程度的增加，死亡风险显著增加; 1年死亡率为15-40%。此外，由于心力衰竭的患病率 (HF)FMR预计将翻一番，从2000年的200多万患者增加到400多万患者 到2030年，美国的患者。定义FMR严重程度、最佳干预时机，以及 最适当干预方法仍有争议。近日，MITRA-FR和 COAPT试验证明了与经皮二尖瓣修复术相比的生存受益， 这表明了更优化选择标准的重要性和必要性。目前患者 二尖瓣夹治疗的选择标准仅基于二尖瓣解剖结构， FMR严重程度的超声心动图标准。心脏磁共振（CMR）提供了 令人兴奋的机会，以解决众多未满足的需求，有关表征FMR和需要 以获得更优的选择标准，从而改善结果。上级精度和再现性， 左心室大小和功能的定量以及金标准组织表征，将CMR定位为 全面表征FMR和潜在肌病的理想成像方式 这些过程显著影响对FMR疗法的反应。目前研究的目标是 通过可解释的无监督，为FMR患者开发个性化风险预测 富含先进CMR成像生物标志物的现象图谱，并确定CMR FMR现代治疗后逆转重构的预测因素。

Project Summary Functional mitral regurgitation (FMR) portends a bleak prognosis and is a common consequence of ischemic and non-ischemic cardiomyopathy (ICM, NICM), where adverse annular and left ventricular (LV) remodeling and/or infarction alters mitral valve (MV) function. Prior studies demonstrate significant increases in mortality risk as severity of FMR increases; mortality rates range from 15-40% at 1 year. Furthermore, as the prevalence of heart failure (HF) is rising, FMR is projected to double from over 2 million patients in 2000 to over 4 million patients in the United States by 2030. Defining FMR severity, optimal timing of intervention, and most appropriate method for intervention remain controversial. Recently, MITRA-FR and COAPT trials demonstrated contrasting survival benefit with percutaneous MV repair, demonstrating the importance and need for more optimal selection criteria. Currently, the patient selection criteria for Mitraclip therapy are solely based on MV anatomy and controversial echocardiographic criteria for FMR severity. Cardiac magnetic resonance (CMR) provides an exciting opportunity to address numerous unmet needs regarding characterizing FMR and the need for more optimal selection criteria for improving outcomes. Superior accuracy and reproducibility for quantification of LV size and function, and gold standard tissue characterization, positions CMR as the ideal imaging modality for comprehensively characterizing FMR and the underlying myopathic processes that significantly impact response to FMR therapies. The goal of the current research is to develop personalized risk prediction for FMR patients through explainable unsupervised phenomapping enriched with advanced CMR imaging biomarkers, and to determine the CMR predictors of reverse remodeling following modern therapies for FMR.