Cardiac Magnetic Resonance IMaging During Arrhythmia

心律失常期间的心脏磁共振成像

• 批准号: 8882525
• 负责人: Aravindan Kolandaivelu
• 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: 2011-07-01 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8882525
• 关键词: Ablation; Affect; Arrhythmia; Atrial Fibrillation; Biomedical Engineering; Cardiac; Cardiac Electrophysiologic Techniques; Cardiac ablation; Cicatrix; Clinical; Clinical Research; Computer Simulation; Data Collection; EKG QRS Complex; Electrocardiogram; Electrophysiology (science); Environment; Fibrosis; Functional disorder; Future; Goals; Histology; Image; Imaging Techniques; Incidence; Institution; K-Series Research Career Programs; Lesion; Magnetic Resonance Imaging; Mechanics; Medical; Mentors; Morphology; Motion; Myocardial; Organ; Outcome; Patients; Procedures; Recording of previous events; Recovery; Recurrence; Research; Research Design; Research Ethics; Resistance; Resolution; Safety; Science; Scientist; Site; Speed; Structure; Techniques; Thermography; Time; Tissues; Training; Universities; Variant; Ventricular Arrhythmia; Ventricular Premature Complexes; Ventricular Tachycardia; Work; base; body system; cardiovascular visualization; career; career development; clinical application; heart motion; image guided therapy; improved; interest; medical schools; patient oriented research; programs; research and development; response

DESCRIPTION (provided by applicant): The aim of the career development and research strategies of this proposal are to build an independent clinician-scientist career focusing on: 1) reliable imaging of parameters that contribute to arrhythmia pathophysiology and ablation procedure outcome, 2) understanding how patient specific structural variations affect arrhythmia propagation and response to treatment, and 3) developing a cellular to organ system level understanding of arrhythmia pathophysiology, that will serve as a basis for future work. My background in clinical electrophysiology, imaging science, and computational modeling is well suited to the goal of improve arrhythmia treatment through individualized image guided therapy. My career development goals will be achieved through a combination of course work and mentored research at the Johns Hopkins University School of Medicine and Department of Biomedical Engineering. Johns Hopkins provides a stimulating research and clinical environment and has a long history of training leaders in patient-oriented research. The institution has a particular strength in studying the cellular to organ level aspects of cardiac electrophysiology and arrhythmia pathophysiology. The structured coursework portion of this career development program will include training in advanced topics in MRI research, image integrated computational modeling, clinical study design, and research ethics. The mentored research potion of this career development award will focus on cardiac magnetic resonance imaging (CMR) during arrhythmia. While many tachy-arrhythmias are curable by catheter ablation, some common conditions, in particular atrial fibrillation and ventricular tachycardia (VT), are sub-optimally managed by current medical and ablation treatments. Cardiac magnetic resonance imaging (CMR) is of increasing interest to cardiac electrophysiology because 1) CMR has the potential to visualize myocardial scar and fibrosis, which are important to VT and atrial fibrillation pathophysiology, and 2) CMR has the potential to visualize ablated tissue as well as gaps in intended regions of ablation. These gaps may not conduct acutely, so that the arrhythmia may not recur immediately after ablation, but the gaps can regain conduction over time. This recovery of conduction is likely a major mechanism for arrhythmia recurrence after ablation. The ability to visualize gaps with CMR, and eliminate those visualized gaps, would likely dramatically reduce the high incidence of VT and atrial fibrillation recurrence after ablation. Current high-resolution CMR techniques for imaging scar, fibrosis, and ablation lesions, however, are not reliable enough for routine clinical application. The proposed research will further develop techniques to perform more reliable high-resolution CMR during arrhythmia and will investigate related CMR applications of 1) predicting successful ablation sites by imaging regional wall motion during arrhythmia and 2) predicting ablation adequacy using arrhythmia resistant CMR thermography. The theme of this work is to provide more specific and individualized image guided therapy toward the goal of increasing the efficacy, speed, and safety of arrhythmia ablation procedures.

描述（由申请人提供）：该提案的职业发展和研究策略的目的是建立一个独立的临床医生科学家职业，重点关注：1）参数的可靠成像，这些参数有助于心律失常病理生理学和消融过程，2）对患者特定的响应的影响，并了解对治疗的源泉，并理解患者特定的响应水平，并理解了对治疗的响应水平，以及3）的影响。病理生理学，这将是未来工作的基础。我在临床电生理学，成像科学和计算建模方面的背景非常适合通过个体化图像指导疗法改善心律不齐治疗。我的职业发展目标将通过课程工作和约翰霍普金斯大学医学院和生物医学工程系的指导研究来实现。约翰·霍普金斯（Johns Hopkins）提供了令人兴奋的研究和临床环境，并在培训以患者为导向的研究方面有悠久的历史。该机构在研究心脏生理学和心律失常病理生理学的细胞到器官水平方面具有特殊的力量。该职业发展计划的结构化课程部分将包括MRI研究，图像综合计算建模，临床研究设计和研究伦理的高级主题培训。该职业发展奖的指导研究药水将重点放在心律不齐期间的心脏磁共振成像（CMR）上。尽管许多速度 - 心律不齐是通过导管消融可治愈的，但某些常见疾病，尤其是心房颤动和心室心动过速（VT），是通过当前的医疗和消融治疗方法来治疗的。心脏磁共振成像（CMR）对心脏电生理学引起了越来越多的兴趣，因为1）CMR具有可视化心肌疤痕和纤维化的潜力，这对于VT和心房纤维化病理生理非常重要，而2）CMR具有可视化的含水组织以及在预期的一部分中可视化的潜力。这些缝隙可能不会急剧进行，因此在消融后可能不会立即复发，但是这些间隙可以随着时间的流逝而恢复传导。这种传导的恢复可能是消融后心律不齐复发的主要机制。通过CMR可视化间隙并消除那些可视化的间隙的能力可能会大大降低消融后VT和房颤复发的高发生率。然而，当前用于成像疤痕，纤维化和消融病变的高分辨率CMR技术对常规临床应用还不够可靠。拟议的研究将进一步开发在心律不齐期间执行更可靠的高分辨率CMR的技术，并将研究1）通过对心律不齐期间成像区域壁运动进行成像和2）使用心律失常阻力CMR CMR热量表来预测成功消融位点的相关CMR应用。这项工作的主题是提供更具体和个性化的图像指导疗法，以提高心律失常消融程序的疗效，速度和安全性。