Quantification and Characterization of Coronary Atherosclerotic Plaque by CT

CT 冠状动脉粥样硬化斑块的定量和表征

• 批准号: 8399031
• 负责人: Armin A. Zadeh
• 金额: $ 13.97万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-01-17 至 2015-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8399031
• 关键词: Advisory Committees; Agreement; Anatomy; Angiography; Arterial Fatty Streak; Award; Baltimore; Biometry; Calcified; Cardiac; Cardiac Death; Cardiology; Characteristics; Clinical; Clinical Investigator; Clinical Research; Clinical Trials Design; Coronary; Coronary Angiography; Coronary Arteriosclerosis; Coronary artery; Detection; Diagnosis; Enrollment; Environment; Epidemiology; Event; Excision; Faculty; Generations; Goals; Gold; Health; Healthcare Systems; Heart Transplantation; High Prevalence; Histopathology; Hospitals; Human; Image; International; Investigation; Laboratories; Lead; Lesion; Location; Maryland; Master' s Degree; Measurement; Mentors; Methods; Metric; Modeling; Monitor; Multicenter Studies; Myocardial; Myocardial Infarction; Nuclear; Outcome; Outcome Study; Patient Schedules; Patients; Perfusion; Population; Prevention; Prevention strategy; Public Health; Public Health Schools; Relative (related person); Research; Research Personnel; Resources; Risk; Schools; Severities; Slice; Societies; Solid; Stenosis; Stress; Stress Tests; Techniques; Testing; Training; Training Programs; Translating; Ultrasonography; Universities; Validation; Work; X-Ray Computed Tomography; attenuation; base; cardiovascular disorder epidemiology; career; cohort; design; detector; diagnostic accuracy; experience; follow-up; improved; in vivo; medical schools; novel; patient oriented research; population based; prognostic; prospective; statistics; tool

DESCRIPTION (provided by applicant): Dr. Zadeh is an academic cardiologist at the Johns Hopkins Hospital in Baltimore, Maryland. He devoted most of his career to patient oriented research with a particular focus on diagnosis and prevention of coronary artery disease. Dr. Zadeh gathered considerable expertise in the use of intravascular ultrasound, conventional coronary angiography, and cardiac computed tomography for the detection and characterization of coronary artery disease. During his first three years on the faculty in the Division of Cardiology at the Johns Hopkins Hospital he was an integral part of a multicenter, international study to evaluate the accuracy of multi-detector computed tomography (MDCT) to detect obstructive coronary artery disease in comparison to conventional angiography. Dr. Zadeh is now the Associate Director of Cardiac CT at the Johns Hopkins Hospital and the Director of the Cardiac CT coronary angiography core laboratory for a second international study comparing MDCT to nuclear stress perfusion imaging and conventional angiography. Dr. Zadeh's long term career goal is to become an independent clinical investigator with the specific objective to translate the new and abundant information from non-invasive coronary artery imaging into improved cardiac event prediction models for population based application and patient management. Ultimately, his goal is to contribute to a decrease in the rates of myocardial infarction and cardiac death in our society and worldwide by implementing better prevention strategies. This award application is designed to advance Dr. Zadeh from the status of a mentored researcher with a solid background in clinical research but with deficiencies in biostatistics and epidemiology to an independent clinical investigator who is able to design and conduct clinical outcome studies based on experience in coronary imaging and coronary artery disease. The objectives of this award will be accomplished through 1) a comprehensive didactic training program in biomedical statistics and epidemiology and 2) the experience of conducting supervised research, which is directly applicable to his long term goal. Specifically, the focus of the first three years of this award will be intensive course work in biomedical statistics, cardiovascular epidemiology, and trial design at the Bloomberg School of Public Health which will lead to a master degree in public health within 3 years. The proposed research plan consists of three parts. Part 1 consists of a retrospective analysis to validate MDCT assessment of total coronary atherosclerotic plaque volume and plaque characteristics compared to intravascular ultrasound in 32 patients enrolled in the CorE-64 multicenter study. The novel aspects of this analysis are the first attempt to fully quantify total coronary atherosclerotic plaque burden by MDCT in comparison to an established standard and the first use of relative attenuation measurements for a more robust assessment of plaque characterization. Part 2 includes a prospective analysis of 320-slice CT for the assessment of total coronary atherosclerotic plaque volume and plaque characteristics compared to histopathology in 30 patients scheduled to undergo heart transplantation. This will be the first such study using current generation MDCT. The unique opportunity to acquire MDCT images in vivo before heart transplantation analysis and ex vivo immediately after excision in comparison to histopathology will provide invaluable information regarding the ability of MDCT to assess coronary artery disease. Lastly, in a third step these validated methods of coronary atherosclerotic plaque volume and characteristics analysis will be applied to predict the risk of cardiac events in 400 patients who are being enrolled for the CorE-320 multicenter study, a diagnostic accuracy study to compare MDCT assessment of coronary anatomy and myocardial stress perfusion imaging to conventional angiography and nuclear stress testing, during a 5-year follow up. Dr. Zadeh's progress to achieving the status of an independent clinical investigator will be closely monitored by his mentor, co-mentor, and a mentoring advisory committee. The Johns Hopkins University School of Medicine and Bloomberg School of Public provide an outstanding training environment and thus are ideally suited to support Dr. Zadeh's transition to an independent investigator with focus on patient-oriented research.

描述（由申请人提供）：Zadeh 博士是马里兰州巴尔的摩约翰霍普金斯医院的学术心脏病专家。他职业生涯的大部分时间致力于以患者为导向的研究，特别关注冠状动脉疾病的诊断和预防。 Zadeh 博士在使用血管内超声、传统冠状动脉造影和心脏计算机断层扫描来检测和表征冠状动脉疾病方面积累了丰富的专业知识。在约翰·霍普金斯医院心脏病科任教的头三年里，他参与了一项多中心国际研究，该研究旨在评估多排计算机断层扫描 (MDCT) 检测阻塞性冠状动脉疾病的准确性至常规血管造影。 Zadeh 博士现担任约翰·霍普金斯医院心脏 CT 副主任和心脏 CT 冠状动脉血管造影核心实验室主任，负责第二项国际研究，将 MDCT 与核应力灌注成像和传统血管造影进行比较。 Zadeh 博士的长期职业目标是成为一名独立的临床研究者，其具体目标是将非侵入性冠状动脉成像中的新的丰富信息转化为改进的心脏事件预测模型，用于基于人群的应用和患者管理。最终，他的目标是通过实施更好的预防策略，为降低我们社会和全世界的心肌梗死和心源性死亡率做出贡献。该奖项申请旨在将 Zadeh 博士从一名具有扎实临床研究背景但在生物统计学和流行病学方面存在缺陷的受指导研究员提升为一名独立临床研究者，能够根据以下领域的经验设计和开展临床结果研究：冠状动脉成像和冠状动脉疾病。该奖项的目标将通过 1）生物医学统计学和流行病学方面的综合教学培训计划和 2）进行监督研究的经验来实现，这直接适用于他的长期目标。具体来说，该奖项前三年的重点将是在彭博公共卫生学院进行生物医学统计学、心血管流行病学和试验设计方面的强化课程，这将在三年内获得公共卫生硕士学位。拟议的研究计划由三部分组成。第 1 部分包括一项回顾性分析，以验证 MDCT 对总冠状动脉粥样硬化斑块体积和斑块特征的评估，与参加 CorE-64 多中心研究的 32 名患者的血管内超声相比。该分析的新颖之处是首次尝试通过 MDCT 与既定标准相比完全量化总冠状动脉粥样硬化斑块负荷，并首次使用相对衰减测量来对斑块特征进行更稳健的评估。第 2 部分包括 320 排 CT 的前瞻性分析，用于评估 30 名计划接受心脏移植的患者的总冠状动脉粥样硬化斑块体积和斑块特征，并与组织病理学进行比较。这将是首次使用当前一代 MDCT 进行此类研究。与组织病理学相比，在心脏移植分析之前获取体内 MDCT 图像以及切除后立即获取离体 MDCT 图像的独特机会将提供有关 MDCT 评估冠状动脉疾病的能力的宝贵信息。最后，在第三步中，这些经过验证的冠状动脉粥样硬化斑块体积和特征分析方法将用于预测参加 CorE-320 多中心研究的 400 名患者的心脏事件风险，该研究是一项比较 MDCT 评估的诊断准确性研究在 5 年随访期间，将冠状动脉解剖和心肌应激灌注成像与传统血管造影和核应激测试进行比较。 Zadeh 博士获得独立临床研究者地位的进展将受到他的导师、共同导师和指导咨询委员会的密切监督。约翰·霍普金斯大学医学院和彭博公立学院提供了出色的培训环境，因此非常适合支持 Zadeh 博士转型为专注于以患者为导向的研究的独立研究者。