The Cardiac Atlas Project

心脏图谱项目

• 批准号: 10435422
• 负责人: Andrew D. McCulloch
• 金额: $ 62.38万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-01-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10435422
• 关键词: 3-Dimensional; Accounting; Adult; Affect; Anatomy; Arrhythmia; Atlases; Award; Basic Science; Biomechanics; Cardiac; Caring; Child; Cicatrix; Clinical; Clinical Data; Clinical Management; Clinical Research; Complex; Congenital Abnormality; Data; Databases; Disease; Electrocardiogram; Electrophysiology (science); Elements; Functional disorder; Geometry; Goals; Heart; Heart Abnormalities; Heart Hypertrophy; Heart failure; Human; Impairment; Individual; Lead; Left; Lesion; Life; Magnetic Resonance; Maps; Measures; Mechanics; Modeling; Myocardial; New Zealand; Operative Surgical Procedures; Patients; Pattern; Pediatric cardiology; Population; Postoperative Period; Property; Pulmonary Valve Insufficiency; Recovery; Research Training; Residual state; Resources; Right Ventricular Dysfunction; Shapes; Sudden Death; Testing; Tetralogy of Fallot; Time; Tricuspid Atresia; United Kingdom; United States; Variant; Ventricular; Ventricular Function; Ventricular Remodeling; Work; age difference; base; biomechanical model; cardiac magnetic resonance imaging; clinical biomarkers; clinical center; clinical translation; clinically significant; cohort; congenital heart disorder; emerging adult; experience; functional improvement; hemodynamics; improved; insight; mechanical properties; non-invasive imaging; outcome prediction; pediatric cardiologist; prevent; prospective; pulmonary valve replacement; repaired; sex; three-dimensional modeling; tool; valve replacement; web-accessible

ABSTRACT Cardiac malformations are the most common type of birth defect. Improvements in the management of complex congenital heart disease have resulted in >90% of those born with congenital heart disease now able to survive into early adulthood. In the U.S. alone, there are more adults with congenital heart disease (~1 million individuals) than children. Tetralogy of Fallot (TOF) is the commonest cyanotic congenital heart lesion, and there is now a large and growing population of adults with TOF. The surgical repairs these patients require early in life often lead to residual pulmonary regurgitation that can cause eventual right ventricular enlargement and dysfunction, and pre-dispose to heart failure, arrhythmias, and sudden death. In the course of clinical management, deciding whether and when to perform pulmonary valve replacement to prevent ventricular decompensation is therefore critical and warrants quantifiable means of assessment. The goal of this project is to expand the current Congenital Heart Disease study of the Cardiac Atlas Project database to include a large cohort of patient with post-operative TOF, and to use the patient cardiac magnetic resonance (CMR) exams and other clinical data to derive statistical atlases of shape, biomechanics and electrical dyssynchrony. These atlases will be used to test hypotheses and discover clinical biomarkers that predict outcomes of pulmonary valve replacement based on variations in ventricular shape, mechanical properties and electromechanical dyssynchrony. The specific aims are: (1) To use disease-specific statistical shape atlases derived from non-invasive imaging exams of patients with TOF to test the hypothesis that specific biventricular shape modes can discriminate patients by their degree of recovery of ventricular function and their extent of reverse cardiac remodeling after valve replacement; (2) To use finite element models of biventricular biomechanics to investigate the extent to which clinically significant relationships between ventricular shape modes and improvements in ventricular function post-valve repair are due to shape alone vs. differences in myocardial material properties; and (3) To determine how dyssynchronous electrical activation patterns that give rise to heterogeneous regional contraction affect hemodynamic improvement and reverse ventricular remodeling after pulmonary valve replacement in TOF patients. This work will have a significant impact on the clinical management of congenital heart disease by providing: new insights into biomechanical alterations in post-operative TOF; new predictors of outcomes following pulmonary valve replacement; and a greatly expanded web-accessible database of CMR exams, models and statistical atlases to facilitate clinical research and training in congenital heart disease.

抽象的 心脏畸形是最常见的出生缺陷类型。管理方面的改进 复杂的先天性心脏病导致>90%的出生时患有先天性心脏病的人现在能够 生存到成年早期。仅在美国，就有更多的成年人患有先天性心脏病（~1 百万人）多于儿童。法洛四联症（TOF）是最常见的紫绀型先天性心脏病， 现在患有 TOF 的成年人数量庞大且不断增长。这些患者需要的手术修复 生命早期经常导致残余肺动脉瓣关闭不全，最终导致右心室扩大 和功能障碍，并容易导致心力衰竭、心律失常和猝死。在临床过程中 管理，决定是否以及何时进行肺动脉瓣置换术以预防心室 因此，失代偿至关重要，需要可量化的评估手段。 该项目的目标是扩大心脏图谱当前的先天性心脏病研究 项目数据库包括大量术后 TOF 患者，并使用患者心脏 磁共振 (CMR) 检查和其他临床数据，以获得形状、生物力学的统计图谱 和电气不同步。这些图谱将用于测试假设并发现临床生物标志物 根据心室形状、机械性能的变化来预测肺动脉瓣置换术的结果 特性和机电不同步。 具体目标是：（1）使用非侵入性的疾病特异性统计形状图谱。 对 TOF 患者进行影像学检查，以检验特定双心室形状模式可以 根据心室功能恢复程度和心脏逆转程度来区分患者 更换阀门后改造； (2) 利用双心室生物力学有限元模型 研究心室形状模式和心室形状模式之间临床显着关系的程度 瓣膜修复后心室功能的改善仅归因于形状与心肌的差异 材料特性； (3) 确定不同步电激活模式如何引起 异质区域收缩影响血流动力学改善和逆转心室重构 TOF 患者的肺动脉瓣置换术。 这项工作将对先天性心脏病的临床治疗产生重大影响 提供： 对术后 TOF 生物力学改变的新见解；新的结果预测因素 肺动脉瓣置换术后；以及大幅扩展的可通过网络访问的 CMR 考试数据库， 模型和统计图谱，以促进先天性心脏病的临床研究和培训。