Noninvasive conduction mapping using Electromechanical Wave Imaging

描述（由申请人提供）：心源性猝死由心脏功能突然丧失（心脏骤停）引起。受害者可能有也可能没有被诊断出心脏病。每年约有31万人死于冠心病（CHD），而没有住院或进入急诊室。这大约是CHD死亡的一半。每天大约有850名美国人，即，每两分钟就有一个美国人。尽管有如此巨大的死亡人数，但目前临床上还没有一种成像方式可以直接和非侵入性地映射整个心脏中的传导波或在存在异常或疾病时的中断。因此，对衰竭心脏中的传导进行非侵入性成像的能力将显著改善这种状况的诊断、治疗和管理。在这项研究中，我们的目标是开发和评估一种新的成像方式，机电波成像（EWI），可以同时映射，在非常高的帧速率，电和机械心脏功能，在存在和不存在的疾病。因此，我们建议证明，EWI技术可以可靠地映射心脏中的传导波，因为它传播沿着室间隔壁，并进入左心室壁和右心室壁;在正常和病理心脏。为了评估该技术的性能，我们将使用一种新的机电模型，该模型将被扩展和修改，以适应本研究的目标。因此，所提出的研究的具体目的是：1）使用犬的电机械模拟模型优化EWI估计; 2）评估EWI在体内传导正常和束分支阻滞的犬中的性能;以及3）使用犬的模拟模型验证体内成像的电机械波。因此，本研究的结果预计将产生一种新的成像方法的心脏的无创传导映射，在没有或很少的额外成本，标准超声心动图，以及同时丰富的计算模型的机电耦合的心脏。该R21应用的重要影响在于，相同的成像模式可以轻松集成到任何商业超声心动图系统中，以便立即转化为临床。此外，它还可以与任何诊断方法（例如心电图和超声心动图）或治疗技术（例如心脏复苏治疗（CRT）和射频（RF）消融）的监测结合安全且无创地应用，用于检测和治疗各种心血管疾病或病症，例如心律失常和心力衰竭。高风险部分与以下事实相关：将电气与心脏的机械功能联系起来可能是一项艰巨的挑战，但考虑到团队的组建和初步结果的可用性，这是可行的。 公共卫生相关声明：每年约有31万人死于冠心病，而没有住院或急诊室。每两分钟就有一个美国人。尽管有如此巨大的死亡人数，目前还没有成像模式，可以显示整个心脏在临床上的传导波。我们的目标是开发和评估一种新的成像方式，机电波成像（EWI），可以非侵入性地图的心脏传导，在存在和不存在的疾病。

DESCRIPTION (provided by applicant): Sudden cardiac death results from an abrupt loss of heart function (cardiac arrest). The victim may or may not have diagnosed heart disease. About 310,000 people a year die of coronary heart disease (CHD) without being hospitalized or admitted to an emergency room. This is about half of all deaths from CHD . about 850 Americans each day, i.e., about 1 American every 2 minutes. Despite this enormous death toll, there is currently no imaging modality in the clinic that can directly and noninvasively map the conduction wave in the entire heart or its disruption in the presence of an abnormality or disease. The ability to non-invasively image conduction in the failing heart would thus significantly improve the diagnosis, treatment, and management of this condition. In this study, our objective is to develop and evaluate a novel imaging modality, Electromechanical Wave Imaging (EWI) that can simultaneously map, at very high frame rates, both the electrical and mechanical cardiac function, at both the presence and absence of disease. We propose thus to demonstrate that the EWI technique can reliably map the conduction wave in the heart as it propagates along the septal wall and into the left and right ventricular walls; in both normal and pathological hearts. To assess the performance of the technique, we will use a novel electromechanical model, which will be extended and modified to fit the objectives of this study. The specific aims of the proposed study are thus to: 1) optimize the EWI estimates using an electromechanical canine simulation model; 2) assess the performance of EWI in dogs with normal conduction and bundle branch block in vivo; and 3) validate the electromechanical wave imaged in vivo using the canine simulation model. As a result, the outcomes of this study are expected to yield a novel imaging methodology for noninvasive conduction mapping of the heart, at no or little additional cost to that of standard echocardiography, as well as simultaneously enrich the computation models of the electromechanical coupling of the heart. The high impact of this R21 application lies in the fact that the same imaging modality can easily be integrated into any commercial echocardiography system for immediate translation to the clinic. Furthermore, it can also be applied safely and noninvasively in conjunction with any diagnostic method, such as electrocardiography and echocardiography or, monitoring of therapeutic techniques, such as Cardiac Resynchronization Therapy (CRT) and radio-frequency (RF) ablation, for the detection and treatment of a wide range of cardiovascular diseases, or conditions, such as arrhythmias and heart failure. The high risk component is associated with the fact that tying the electrical with the mechanical function of the heart can be a formidable, but feasible given the team assembled and preliminary results available, challenge. PUBLIC HEALTH RELEVANCE STATEMENT: About 310,000 people a year die of coronary heart disease without being hospitalized or admitted to an emergency room. This is about 1 American every 2 minutes. Despite this enormous death toll, there is currently no imaging modality that can display the conduction wave in the entire heart in the clinic. Our objective is to develop and evaluate a novel imaging modality, Electromechanical Wave Imaging (EWI) that can noninvasively map the cardiac conduction, at both the presence and absence of disease.