Cardiac Performance by Quantitative Echocardiography

定量超声心动图的心脏表现

• 批准号: 7455905
• 负责人: JOHN GORCSAN
• 金额: $ 14.87万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2001
• 资助国家: 美国
• 起止时间: 2001-07-01 至 2011-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7455905
• 关键词: Acute; Affect; American; Animal Model; Apical; Award; Biochemical Markers; Biotechnology; Cardiac; Cardiac Catheterization Procedures; Caring; Chronic; Clinical Research; Clinical assessments; Consensus; Coupled; Data; Devices; Disease; EFRAC; Echocardiography; Elevation; Excision; Exercise; Extramural Activities; Faculty; Favorable Clinical Outcome; Fellowship; Figs - dietary; Foundations; Funding; Grant; Health; Heart Transplantation; Heart failure; Human; Image; Inflammation; Inflammatory; Invasive; Lead; Left; Left Ventricular Dysfunction; Left Ventricular Function; Life; Life Expectancy; Measures; Mechanics; Medicine; Mentors; Methods; Myocardial; Myocardial dysfunction; Numbers; Organ Donor; Organ Transplantation; Outcome; Oxygen Consumption; Patients; Peer Review; Performance; Placement; Positioning Attribute; Predictive Value of Tests; Preparation; Principal Investigator; Probability; Process; Productivity; Publications; Quality of life; Radial; Randomized Controlled Clinical Trials; Recovery; Recovery of Function; Reporting; Risk; Role; Score; Shock; Site; Societies; Specificity; Testing; Time; Tissues; Transplantation; Tumor Necrosis Factor-alpha; Tumor Necrosis Factors; United States; Ventricular; Walking; base; concept; cytokine; experience; hemodynamics; human TNF protein; implantation; improved; insight; instrumentation; myocardium neoplasm; novel; novel strategies; patient oriented research; professor; programs; response; success; ventricular assist device

DESCRIPTION (provided by applicant): This is a competing K24 renewal application for the important project, "Cardiac Performance by Quantitative Echocardiography." The candidate's productivity in peer-reviewed publications, success in extramural funding, and vigorous mentoring activities in patient-oriented research have been a direct result of this award. The candidate been recently been promoted to tenured Professor of Medicine and has mentored 7 trainees in clinical research resulting in 12 peer-reviewed publications with the trainee as 1st author and the candidate as senior author; 8 others are submitted or in preparation. All trainees successfully obtained competitive support with the candidate as mentor, including a peer-reviewed Fellowship Award and Outcomes Grant from the American Society of Echocardiography. All have or will be going on to full-time academic faculty positions. This renewal will continue and intensify these activities. Project 1 tests the key hypotheses that novel load-independent echocardiographic left ventricular (LV) functional measures can identify heart failure (HF) patients on assist device (LVAD) who have LV recovery, and that mvocardial inflammation and expression of TNF-alpha are markers for reversible LV dysfunction. Our exciting preliminary data on 36 LVAD patients demonstrate identification of LV recovery and successful LVAD removal in 10. This proposal will test our novel imaging approach of preload-adjusted maximal power, in comparison to a routine clinical assessment that includes exercise oxygen consumption and right heart catheterization. We will also correlate LV recovery with markers of myocardial inflammation and TNF-alpha expression to add mechanistic insight. Project 2 focuses on cardiac resynchronization therapy (CRT) that benefits many HF patients, but 25-35% are still non-responders using QRS criteria. Project 2 tests the key hypotheses: 1) that novel imaging markers of mechanical dyssynchrony can reliably predict patient response to CRT and 2) that imaging-guided LV lead placement at the site of latest mechanical activation will result in a more favorable clinical outcome than routine LV lead placement. Our novel approaches include tissue Doppler and speckle tracking to assess longitudinal and radial mechanics. Our data on 42 patients predict acute response to CRT (up to 95% sensitivity and 100% specificity), however, predicting long-term outcome is unclear. We have also shown that LV lead placement concordant with site of latest mechanical activation results in greater improvements than routine lead positioning. This proposal will test the predictive value of our imaging dyssynchrony markers in 320 CRT patients and includes a randomized trial of image-guided LV lead position vs. routine care. Primary outcome variables (Packer composite HF score, 6 min. walk test, and ejection fraction) will be assessed at 6 mo. and 1 year. These studies will provide valuable insight to the correct utilization of these extensive therapies and provide abundant opportunities for mentoring of trainees.

描述（由申请人提供）： 这是重要项目的竞争性K24续订应用程序，“通过定量超声心动图进行心脏绩效”。候选人在同行评审的出版物中的生产力，校外资金的成功以及以患者为导向的研究中的剧烈指导活动是该奖项的直接结果。 该候选人最近被晋升为终身医学教授，并指导了7名学员，从事临床研究，导致了12名同行评审的出版物，该出版物是第一作者，候选人是高级作者； 8其他人已提交或准备。所有学员都成功地获得了候选人作为导师的竞争支持，包括美国超声心动图学会的同行评审奖学金奖和成果赠款。所有人都有或将继续担任全日制学术教师职位。这种更新将继续并加强这些活动。项目1检验了关键假设，即新型的无超声心动图左心室（LV）功能措施可以鉴定出具有LV恢复的辅助设备（LVAD）的心力衰竭（HF）患者，并且MVOPARDIAL炎症和TNF-Alpha的表达和TNF-Alpha是可逆LV功能障碍的标志。我们对36名LVAD患者的激动人心的初步数据显示，与日常调整后的最大功率相比，该提案将测试我们的新型成像方法，与常规的临床评估相比，该方法包括锻炼氧气消耗氧气和右心导管。我们还将将LV恢复与心肌炎症和TNF-Alpha表达的标记相关联，以增加机械洞察力。项目2专注于受益于许多HF患者的心脏重新同步治疗（CRT），但使用QRS标准为25-35％。项目2测试关键假设：1）机械异步的新型成像标记可以可靠地预测患者对CRT的反应和2）2）在最新机械激活部位成像引导的LV铅放置将导致比常规LV Lead Pladement更有利的临床结果。我们的新方法包括组织多普勒和斑点跟踪，以评估纵向和径向力学。我们关于42名患者的数据预测对CRT的急性反应（高达95％的敏感性和100％的特异性），但是，预测长期预后尚不清楚。我们还表明，与最新机械激活的位点相一致的LV铅位置会导致比常规铅定位更大的改进。该提案将测试320名CRT患者成像异质标记的预测价值，并包括图像引导的LV铅位置与常规护理的随机试验。主要结果变量（Packer复合HF评分，6分钟。步行测试和射血分数）将在6 mo处评估。和1年。这些研究将为正确利用这些广泛的疗法提供宝贵的见解，并为学员提供丰富的机会。