Cardiac Magnetic Resonance Imaging After Cardiac Resynchronization Therapy

心脏再同步治疗后的心脏磁共振成像

• 批准号: 9353459
• 负责人: Kenneth C Bilchick
• 金额: $ 6.37万
• 依托单位: UNIVERSITY OF VIRGINIA
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-16 至 2019-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9353459
• 关键词: Address; Agreement; American; Cardiac; Cardiopulmonary; Characteristics; Cicatrix; Clinical Trials; Computer Simulation; Contracts; Data; Data Quality; Defibrillators; Devices; Diagnosis; Disease; EFRAC; Echocardiography; Enrollment; Environment; Exercise stress test; Gadolinium; Generations; Growth; Health; Heart; Heart Diseases; Heart failure; Hospitalization; Image; Image Analysis; Imaging Device; Implant; Individual; Journals; Laboratories; Lead; Left; Left Ventricular Function; Left Ventricular Remodeling; Left ventricular structure; Location; MRI Scans; Magnetic Resonance Imaging; Measurement; Measures; Mechanics; Mentored Patient-Oriented Research Career Development Award; Methods; Mind; Mission; Modification; Morphologic artifacts; Myocardial; Myocardial Infarction; Myocardial Ischemia; National Heart, Lung, and Blood Institute; Pacemakers; Patient Selection; Patients; Phase; Physiologic pulse; Positioning Attribute; Procedures; Protocols documentation; Publishing; Pump; Recovery; Reproducibility; Research; Research Personnel; Site; Structure; Symptoms; Testing; Thick; United States; Ventricular; Ventricular End-Systolic Volumes; Ventricular Remodeling; Work; base; cardiac resynchronization therapy; cardiovascular visualization; cohort; cost effective; design; effective therapy; heart disease risk; image guided; imaging modality; implantation; improved; insight; response; spatial relationship; statistics; therapy development; therapy outcome

Project Summary The main objective of this research is to use cardiac magnetic resonance imaging (MRI) after implantation of cardiac resynchronization therapy (CRT) for heart failure to provide very detailed and high-quality data regarding the impact of left ventricular (LV) pacing site characteristics on LV structure and function after CRT. We believe this work will provide insights into mechanisms of CRT response and nonresponse, as well as ways to improve CRT implementation. The importance of heart failure is characterized by the following statistics: at least 5 million people in the United States have heart failure, 2.5 million require hospitalization, and more than 500,000 are diagnosed with heart failure each year. As a result, this research is highly aligned with the mission of the National Heart, Lung, and Blood Institute to enhance the health of individuals with heart disease or at risk for heart disease so they can live longer and more fulfilling lives. CRT involves implantation of an advanced pacemaker/defibrillator attached to three wires in the heart designed to make unevenly pumping hearts contract more synchronously and effectively. Although CRT is very beneficial for many patients, nonresponder rates are typically 35-50% when implants are not guided by imaging, often because of suboptimal positioning of the pacing wires with respect to scar and mechanical activation. During the K23 award, the PI demonstrated how MRI characterization of scar with late gadolinium enhancement and strain with the DENSE (Displacement Encoding with Stimulated Echoes) method before could be used to identify optimal pacing sites, but direct MRI evaluation of the effect of LV pacing sites on LV remodeling after CRT had not been possible until just recently when a new generation of CRT defibrillators was approved for conditional use in the MRI environment in February 2016. A post-CRT cardiac MRI provides is quite valuable because it can provide highly detailed and reproducible data regarding LV structure and function using optimized pulse sequences for strain, volumes, wall thickness, synchrony, and scar. In this study, post-CRT MRI findings will be compared with pre-CRT MRI findings to show how the LV pacing lead location relative to mechanical activation and scar alters LV remodeling after CRT and provide additional insights regarding the optimal spatial relationship between LV lead position and scar in the heart. MRI results will be compared with echocardiography results, and the findings promise to demonstrate how these imaging modalities can be used together for the benefit of CRT patients. We will enroll 40 CRT patients who will have cardiac MRI, echocardiography, cardiopulmonary exercise testing, symptom assessment, and laboratory testing before and 6 months after CRT. The project is expected to have a high impact on the field and lead to important improvements in CRT implementation. This work will also facilitate the PI's progression to independence by providing important data for subsequent work on an MRI-guided clinical trial for CRT and the development of computational models for LV remodeling after CRT based on LV pacing lead placement. 1

项目摘要 这项研究的主要目的是在植入后使用心脏磁共振成像（MRI） 心脏失败的心脏重新同步疗法（CRT）提供有关非常详细且高质量的数据 左心室（LV）起搏位点特征对CRT后LV结构和功能的影响。我们相信 这项工作将提供有关CRT响应和无响应机制的见解，以及改进的方法 CRT实施。心力衰竭的重要性的特征是以下统计数据：至少500万 美国的人患有心力衰竭，250万需要住院，超过500,000 每年诊断出心力衰竭。结果，这项研究与国家的使命高度保持一致 心脏，肺和血液研究所，以增强心脏病患者的健康或患心脏病的风险 因此，他们可以生活更长，更充实的生活。 CRT涉及植入高级起搏器/除颤器 在心脏的三根电线上附着，旨在使不均匀的抽水心脏更加同步 并有效。尽管CRT对许多患者非常有益，但无响应率通常为35-50％ 当植入物不通过成像引导时，通常是由于与起搏线的次优定位 尊重疤痕和机械激活。在K23奖中，PI演示了MRI的表征 疤痕，延迟升高，并与致密（刺激的位移编码） 以前可以使用Echoes）方法来识别最佳起搏位点，但直接对MRI评估 CRT之后的LV起搏站点直到最近新一代不可能 CRT除颤器于2016年2月被批准在MRI环境中有条件使用。 心脏MRI提供的提供非常有价值，因为它可以提供有关有关的高度详细和可重复的数据 使用优化的脉冲序列的LV结构和功能，用于应变，体积，壁厚，同步和同步和 瘢痕。在这项研究中，将将CRT MRI后发现与CRT MRI的发现进行比较，以显示LV如何 相对于机械激活和疤痕改变CRT后LV重塑的起搏铅位置，并提供 关于LV铅位置与心脏中疤痕之间最佳空间关系的其他见解。 MRI 结果将与超声心动图结果进行比较，结果有望证明这些结果如何 成像方式可以一起使用，以使CRT患者受益。我们将注册40名CRT患者 进行心脏MRI，超声心动图，心肺运动测试，症状评估和实验室 CRT之前和6个月进行测试。预计该项目将对该领域产生重大影响，并导致 CRT实施的重要改进。这项工作还将促进PI的发展 通过为随后的CRT和MRI引导临床试验提供重要的数据来独立性 基于LV起搏线索放置后CRT后LV重塑的计算模型的开发。 1

项目成果

Obesity paradox in group 1 pulmonary hypertension: analysis of the NIH-Pulmonary Hypertension registry.

• DOI: 10.1038/ijo.2017.45
• 发表时间: 2017-08
• 期刊: International journal of obesity (2005)
• 作者: Mazimba S;Holland E;Nagarajan V;Mihalek AD;Kennedy JLW;Bilchick KC
• 通讯作者: Bilchick KC

Right atrial to left atrial volume index ratio is associated with increased mortality in patients with pulmonary hypertension.

• DOI: 10.1111/echo.14149
• 发表时间: 2018-11
• 期刊: Echocardiography (Mount Kisco, N.Y.)
• 作者: Mysore MM;Bilchick KC;Ababio P;Ruth BK;Harding WC;Breathett K;Chadwell K;Patterson B;Mwansa H;Jeukeng CM;Kwon Y;Kennedy JLW;Mihalek AD;Mazimba S
• 通讯作者: Mazimba S