An Integrated and Automated Tool for Quantification of Biomechanics in Fetal and Neonatal Echocardiography

用于量化胎儿和新生儿超声心动图生物力学的集成自动化工具

• 批准号: 10508997
• 负责人: Ronald Mark Payne
• 金额: $ 24.22万
• 依托单位: PURDUE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-15 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10508997
• 关键词: Address; Adult; Age; Age-Years; Algorithmic Analysis; Biomechanics; Biomedical Engineering; Birth; Cardiac; Cessation of life; Child; Childhood; Clinical; Clinical Management; Clinical Sciences; Color; Common Ventricle; Computer software; Congenital Abnormality; Consequentialism; Data; Development; Diagnosis; Diagnostic; Diastolic blood pressure; Dimensions; Disease; Disease-Free Survival; EFRAC; Echocardiography; Evolution; Failure; Fetal Heart; Fontan Procedure; Functional disorder; Goals; Growth; Heart; Heart Ventricle; Heart failure; Hypoplastic Left Heart Syndrome; Indiana; Infant; Infrastructure; Intervention; Longitudinal prospective study; Measurement; Measures; Mechanics; Methods; Morphology; Neonatal; Operative Surgical Procedures; Outcome; Palliative Surgery; Patient-Focused Outcomes; Patients; Pattern; Pediatric Hospitals; Pediatric cardiology; Physiologic intraventricular pressure; Pregnancy; Prognosis; Reproducibility; Scanning; Single ventricle congenital heart disease; Survival Rate; Testing; Time; Transcend; Universities; Ventricular; Work; automated analysis; base; clinical practice; clinical prognosis; congenital heart disorder; design; fetal; heart function; hemodynamics; improved; medical schools; novel; outcome prediction; palliation; patient stratification; pediatric heart failure; pediatric patients; postnatal; precision medicine; predictive tools; pressure; prognostic; prospective; risk stratification; success; tool

PROJECT SUMMARY The single ventricle (SV) heart is a critical birth defect that requires several palliative surgeries for patient survival. Even when these surgeries are considered successful, SV hearts can develop heart failure (HF), resulting in just a 43% 30-years of age survival rate for patients. The SV's biomechanics underlying the progression to HF could provide critical enabling information that could help improve SV patients' outcomes and surgical planning. Despite that, SV biomechanics remain not well understood. Existing echocardiography analysis tools are designed for adult hearts and cannot accurately or reproducibly evaluate fetal and neonatal echocardiograms. Thus, currently, there are no available tools to study the biomechanics of SV hearts. Beyond this, conventional metrics such as ejection fraction (EF) fail to capture SV hearts' growth and remodeling. We previously developed a novel, automated analysis tools that can quantify ventricular biomechanics from routine B-mode and color Doppler recordings. We tested these tools using pre- and postnatal normal and hypoplastic left heart patients. We simultaneously measured conventional metrics (e.g., EF), global longitudinal strain and strain rate, interventricular pressure difference, and flow energy losses. Such measurements have never been possible using existing echocardiogram analysis tools. Our initial findings indicated these metrics differed between SV and normal postnatal hearts, with statistical significance. We propose to test the hypothesis that differences in diastolic flow, pressure, and energy-loss, correlate with pre- and post-Fontan procedure outcomes and predict progression to failure. We will aim to (i) optimize and establish the accuracy and reliability of our novel and integrated echocardiography analysis for SV hearts and subsequently use our tools to establish quantitative biomechanics and hemodynamic differences between healthy and SV hearts. Further, we aim to: (ii) analyze SV hearts using a prospective longitudinal study to develop correlations between the evolution of hemodynamics and biomechanics parameters of SV hearts with time-point outcomes, such as growth and event-free survival at fetal, neonatal, and pre- and post-Fontan stages. This project aims to improve predictions of outcomes and enable better surgical planning and clinical management for children with SV heart defects. This project's goal would be to establish our tools in clinical practice.

项目摘要 单个心室（SV）心脏是一个严重的先天缺陷，需要为患者进行几次姑息手术 生存。即使这些手术被认为是成功的，SV心也可以发展心力衰竭（HF）， 导致患者的年龄生存率仅为43％。 SV的生物力学基础 到HF的发展可能会提供关键的启用信息，以帮助改善SV患者的结果和 手术计划。尽管如此，SV生物力学仍然不太了解。现有的超声心动图 分析工具专为成人心脏而设计，无法准确或可重复评估胎儿和新生儿 超声心动图。因此，目前没有可用的工具来研究SV心脏的生物力学。 除此之外，诸如射血分数（EF）之类的常规指标无法捕获SV心脏的增长和重塑。 我们以前开发了一种新颖的自动分析工具，可以从 常规B模式和颜色多普勒记录。我们使用产后和后正常和 左心患者发育不全。我们同时测量了常规指标（例如EF），全球纵向 应变和应变速率，介入压力差和流量损失。这样的测量已有 使用现有的超声心动图分析工具，永远无法使用。我们的最初发现表明这些指标 SV和正常出生后心脏有所不同，具有统计学意义。 我们建议检验以下假设：舒张流，压力和能量损失的差异， 与联邦前后的手术结果相关，并预测失败的进展。我们将瞄准 （i）优化和建立我们的小说和集成超声心动图的准确性和可靠性 SV心脏的分析，随后使用我们的工具来建立定量生物力学和 健康和SV心之间的血流动力学差异。此外，我们的目标是：（ii）使用 前瞻性纵向研究，以发展血液动力学演变与 SV心脏的生物力学参数具有时间点结果，例如胎儿生长和无事件生存， 新生儿以及前后阶段。 该项目旨在改善结果的预测，并实现更好的手术计划和临床 患有SV心脏缺陷的儿童的管理。该项目的目标是在临床上建立我们的工具 实践。