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：出于提高心脏成像价值的未满足需求的动机 医疗保健系统，该提案旨在提高心血管疾病的质量并扩大其适用性 MR (CMR) 适用于植入心脏植入电子设备 (CIED) 的患者。 CMR 如果成功，将提供更好的服务 对于 CIED 患者而言，其价值高于其他心脏成像方式（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、VT 消融、电池更换、CRT 升级）。作为一种多功能模式，CMR 是 能够对心室功能、血流灌注、疤痕、瓣膜血流等进行综合评估。 除了诊断之外，CMR 已被证明可以预测缺血性心脏病中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 CIED 以及心律失常和呼吸不良引起的临床上显着的图像伪影， 超过 300 万接受 CIED 的美国人可能无法从标准 CMR 中受益。 为了弥补心脏成像方面的这一差距，我们建议协同应用两种先进的 CMR 技术：(1) 能够抑制 CIED 引起的图像伪影的宽带脉冲序列和 (2) 压缩感知（CS）加速实时序列，能够实现对 心律失常和呼吸运动并降低特定吸收率。科学前提的支持是 我们在开发和翻译宽带和 CS CMR 序列方面拥有超过 9 年的经验。通过利用 我们在 CS 方面的资源由 R01HL138578 和 R21EB024315 支持，我们组装了一套独特的 CS- 加速实时宽带 CMR 脉冲序列以及内联图像重建方法 使用 CIED 对患者进行成像。综合实时宽带应力 CMR 结合评估 心室功能、灌注、瓣膜功能和疤痕，用于评估新发或恶化的心血管疾病 症状将使医疗费用减少 47%（1185.67 美元医疗保险报销技术 与当前的临床实践相比，扫描时间（25 分钟）减少 88% 应激 SPECT（1544.80 美元，3 小时）和静息超声心动图（707.96 美元，25 分钟）。为了附加值，疤痕 通过 CMR 评估的负担将有助于预测 CIED 患者的 MACE 并指导 EP 程序。 该提案的目的是：（1）评估实时宽带应力 CMR 的准确度和精密度 CAD患者模拟CIED植入，(2)确定实时宽带的预后价值 CIED 患者的应激 CMR，以及 (3) 验证实时宽带晚期钆增强的 CMR CIED 患者的电解剖图。该提案具有很高的影响潜力，因为拟议的实际 时间 测试 宽带 CMR 技术将作为单一诊断/预后/术前技术广泛应用 为越来越多的 CIED 患者提供服务，从而增加了心脏成像对该队列的价值。