Echocardiography to Predict Recurrent IMR After Surgical Mitral Valve Replacement

超声心动图可预测二尖瓣置换术后复发的 IMR

• 批准号: 8108917
• 负责人: Robert C Gorman
• 金额: $ 69.02万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-06-06 至 2015-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8108917
• 关键词: Address; Affect; Age; American; Anatomy; Cardiac Volume; Clinical; Clinical Trials; Coronary Artery Bypass; Dilatation - action; Echocardiography; Enrollment; Goals; Image; Individual; Infarction; Left; Left Ventricular Ejection Fraction; Left Ventricular Remodeling; Measures; Medical; Methods; Mitral Valve; Mitral Valve Insufficiency; Modeling; Myocardial Infarction; Operative Surgical Procedures; Outcome; Patients; Population; Recurrence; Risk; Secondary to; Severities; Stratification; Surgeon; Techniques; Therapeutic; Three-Dimensional Echocardiography; Two-Dimensional Echocardiography; Ventricular; base; follow-up; high risk; improved; mitral valve replacement; mortality; papillary muscle; repaired; tool; two-dimensional; valve replacement

DESCRIPTION (provided by applicant): Ischemic mitral regurgitation (IMR) affects 1.6 to 2.8 million Americans and increases mortality even when mild. There is a strong graded relationship between the severity of IMR and reduced survival. Valve incompetence in IMR occurs due to a variable combination of leaflet tethering and annular dilation. Mitral valve (MV) repair with undersized annuloplasty rings has become the preferred treatment; however, while annuloplasty effectively addresses annular dilatation, it does not improve and may exacerbate leaflet tethering. MV repair is associated with a 30% recurrence rate of significant IMR (e2+) within 6 months after surgery. This high recurrence rate significantly limits the efficacy of MV repair for IMR. It is likely that a standardized and reliably efficacious surgical therapeutic approach to IMR will not be achievable until the confounding phenomena of recurrent mitral regurgitation can be better understood and subsequently neutralized. A patient-specific approach to treatment, guided by preoperative imaging-based risk stratification for recurrent IMR, is apt to be the best means for achieving this important goal. It is the intent of the proposed project to develop such a tool for risk stratification. The central hypothesis of this proposal is that the degree of pre-repair mitral leaflet tethering determines the degree of recurrent mitral regurgitation after ring annuloplasty for IMR. We further hypothesize that leaflet tethering can be effectively quantified preoperatively by echocardiography and that three-dimensional echocardiography (3DE) is superior to standard two-dimensional echocardiography (2DE) for predicting the degree of recurrent IMR. The proposed study seeks to develop echocardiographic techniques to predict, preoperatively, the degree of recurrent IMR that can be expected for an individual patient within the first year after surgery. The anticipated results of the proposed study will allow surgeons to determine which IMR patients are best treated with standard MV repair (i.e. ring annuloplasty) and which are better served by valve replacement. Such an approach will limit recurrent IMR and simultaneously maximize the number of patients who realize the benefits of MV repair. Both results will improve clinical outcomes. We propose to enroll 378 patients at three high-volume cardiac surgical centers over a 5 year period. Intraoperative 2DE and 3DE parameters will be correlated with the degree of recurrent IMR at 6 and 12 months after surgery. PUBLIC HEALTH RELEVANCE: This study seeks to develop echocardiographic-based analytic tool to predict, preoperatively, the degree of recurrent IMR after mitral valve repair surgery. The results of this study will allow surgeons to identify patients who are likely to fail mitral valve repair and who would be better served by valve replacement. This approach will limit recurrent IMR and simultaneously maximize the number of patients who realize the benefits of mitral valve repair.

描述（由申请人提供）：缺血性二尖瓣反流 (IMR) 影响着 1.6 至 280 万美国人，即使症状轻微，也会增加死亡率。 IMR 的严重程度与生存率降低之间存在很强的分级关系。 IMR 中的瓣膜功能不全是由于小叶栓系和瓣环扩张的可变组合而发生的。使用尺寸较小的瓣环成形环修复二尖瓣 (MV) 已成为首选治​​疗方法；然而，虽然瓣环成形术有效地解决了瓣环扩张问题，但它并没有改善并且可能加剧瓣叶束缚。 MV 修复与术后 6 个月内 30% 的显着 IMR (e2+) 复发率相关。这种高复发率极大地限制了 MV 修复 IMR 的疗效。在更好地理解并随后消除复发性二尖瓣反流的混杂现象之前，很可能无法实现标准化且可靠有效的 IMR 手术治疗方法。以术前基于影像学的复发性 IMR 风险分层为指导的针对患者的治疗方法可能是实现这一重要目标的最佳手段。拟议项目的目的是开发这样一个风险分层工具。该提案的中心假设是，修复前二尖瓣小叶栓系的程度决定了 IMR 环成形术后复发性二尖瓣反流的程度。我们进一步假设，术前可以通过超声心动图有效量化瓣叶束缚，并且三维超声心动图（3DE）在预测复发性 IMR 程度方面优于标准二维超声心动图（2DE）。拟议的研究旨在开发超声心动图技术，以在术前预测个体患者术后第一年内可能出现的 IMR 复发程度。拟议研究的预期结果将使外科医生能够确定哪些 IMR 患者最适合采用标准 MV 修复术（即瓣环成形术）进行治疗，哪些患者更适合进行瓣膜置换术。这种方法将限制复发性 IMR，同时最大限度地增加意识到 MV 修复益处的患者数量。这两个结果都将改善临床结果。我们建议在 5 年内在三个大容量心脏外科中心招募 378 名患者。术中 2DE 和 3DE 参数将与术后 6 个月和 12 个月的 IMR 复发程度相关。 公共健康相关性：本研究旨在开发基于超声心动图的分析工具，以在术前预测二尖瓣修复手术后复发 IMR 的程度。这项研究的结果将使外科医生能够识别二尖瓣修复可能失败的患者以及瓣膜置换术可以更好地治疗哪些患者。这种方法将限制复发性 IMR，同时最大限度地增加意识到二尖瓣修复益处的患者数量。