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

项目摘要/摘要：在未得到满足的需求的推动下，增加我们的心脏成像的价值 这项建议旨在提高心血管系统的质量，扩大其适用性 心脏可植入电子设备(CIED)患者的MR(CMR)。如果成功，CMR将提供更好的效果 对CIED患者的诊断价值高于其他心脏影像检查(SPECT、超声心动图)，因为它们 患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、室上性心动过速消融、电池更换、CRT升级)。作为一种多功能的医疗方式，CMR是 能够进行包括心功能、血流灌注、疤痕和瓣膜血流在内的全面评估。 除了诊断之外，CMR已被证明可以预测两种情况下的主要不良心脏事件(MACE) 和非缺血性心肌病患者，并为电生理操作提供指导。 不幸的是，由于CIED引起的临床显著图像伪影以及心律失常和呼吸困难- 在成像期间持有，超过300万患有CIED的美国人可能无法从标准的CMR中受益。 为了弥补心脏成像的这一差距，我们建议协同应用两种先进的CMR技术：(1) 能够抑制由CIED引起的图像伪影的宽带脉冲序列和(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。科学的前提是由 我们在开发和翻译宽带和CS CMR序列方面的经验(&gt；9年)。通过利用 我们在CS中的资源在R01HL138578和R21EB024315的支持下，我们组装了一套独特的CS- 加速的实时宽带CMR脉冲序列和在线图像重建方法 对患有CIED的患者进行成像。宽带应力CMR综合实时综合评价 用于评估新的或恶化的心血管疾病的心功能、血流灌注、瓣膜功能和疤痕 症状将使医疗费用降低47%(1185.67美元的联邦医疗保险报销技术 和阅读费用)，与当前的临床实践相结合，扫描时间(25分钟)减少88% 负荷断层扫描(1544.80美元，3小时)和静息超声心动图(707.96美元，25分钟)。对于附加值，刀疤 用CMR评估负荷将有助于预测CIED患者的MACE和指导EP手术。 该方案的目的是：(1)评估实时宽带应力CMR的准确性和精密度 模拟CIED植入的冠心病患者，(2)确定实时宽带技术的预后价值 CIED患者的应激CMR，以及(3)验证实时宽带晚期Gd增强CMR与 CIED患者的电解剖标测。这项提议具有很高的影响潜力，因为拟议的真实- 时间 测试 宽带CMR技术将被广泛应用为单一的诊断/预后/术前检查 对于越来越多的CIED患者，从而增加了心脏成像对这一队列的价值。

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.