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

针对心脏植入电子设备患者的实时宽带心脏 MRI

• 批准号: 10327327
• 负责人: Daniel Kim
• 金额: $ 62.76万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-03-04 至 2023-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10327327
• 关键词: Ablation; American; Anatomy; Arrhythmia; Blood Vessels; Blood flow; Breathing; Cardiac; Cardiovascular system; Catheters; Cessation of life; Characteristics; Cicatrix; Clinical; Complex; Consensus; Coronary Arteriosclerosis; Devices; Diagnosis; Diagnostic; Disease; EFRAC; Echocardiography; Electronics; Electrophysiology (science); Evaluation; Event; Fees; Gadolinium; Healthcare Fees; Healthcare Systems; Heart Diseases; Hour; Image; Implant; Implantable Defibrillators; Infarction; Ischemia; Left Ventricular Ejection Fraction; Location; Magnetic Resonance; Magnetic Resonance Imaging; Medicare; Methods; Modality; Morphologic artifacts; Morphology; Motion; Myocardial; Participant; Patient imaging; Patients; Perfusion; Physicians; Physiologic pulse; Procedures; Randomized; Reading; Reproducibility; Research; Research Design; Resources; Rest; Scanning; Series; Shock; Stress; Symptoms; Technology; Testing; Time; Tissues; Translating; Validation; Variant; Vendor; Ventricular Function; Ventricular Tachycardia; absorption; base; cardiac magnetic resonance imaging; clinical practice; clinical translation; clinically significant; cohort; experience; experimental study; heart imaging; heart rhythm; image reconstruction; imaging modality; implantation; improved; novel; prognostic; prognostic value; prophylactic; single photon emission computed tomography; structural heart disease

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.

项目摘要/摘要：由未满足的动机需要增加我们的心脏成像的价值 医疗保健系统，该建议旨在提高质量并扩大心血管的适用性 患有心脏植入电子设备（CIED）患者的MR（CMR）。 CMR，如果成功的话，可以更好 比其他心脏成像方式（SPECT，超声心动图）的价值，因为它们 具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，VT消融，电池更换，CRT升级）。作为多功能方式，CMR是 能够进行全面的评估，包括心室功能，灌注，疤痕和瓣膜流。 除诊断外，CMR已被证明可以预测两种缺血性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CIEDS和心律不齐和呼吸不佳引起的临床意义图像伪像 在成像过程中持有，超过300万美国人可能不会从标准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高级CMR技术：（1） 能够抑制CIEDS诱导的图像伪影的宽带脉冲序列和（2） 压缩传感（CS）加速的实时序列，能够实现对 心律不齐和呼吸运动并降低了特定的吸收率。科学前提得到 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 R01HL138578和R21EB024315支持的CS资源，我们组装了一套CS-的独特套件 加速实时宽带CMR脉冲序列以及内联图像重建方法 成像患者用CIED成像。全面的实时宽带应力CMR结合评估 心室功能，灌注，瓣膜功能和疤痕，用于评估新的或恶化的心血管 症状将使医疗费用减少47％（$ 1185.67 Medicare报销技术 与当前的临床实践相比 压力SPECT（$ 1544.80，3小时）和静止超声心动图（707.96，25分钟）。为了增加价值，疤痕 用CMR评估的负担将有助于预测CIED患者的MACE和指导EP程序。 该提案的目的是：（1）评估实时宽带应力CMR的准确性和精度 CAD患者具有模拟CID植入的患者，（2）确定实时宽带的预后价值 CIED患者的压力CMR，（3）验证实时宽带晚期Gadolinium增强了CMR CIED患者的电工映射。该提议具有很高的影响潜力，因为拟议的现实 时间 测试 宽带CMR技术将广泛适用于单个诊断/预后/前术 对于越来越多的CIED患者，该队列的心脏成像值增加。