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

项目概要 本研究的主要目的是在植入心脏后使用心脏磁共振成像（MRI） 针对心力衰竭的心脏再同步治疗 (CRT) 提供非常详细和高质量的数据 CRT 后左心室 (LV) 起搏部位特征对 LV 结构和功能的影响。我们相信 这项工作将深入了解 CRT 响应和无响应的机制，以及改进的方法 CRT 实施。心力衰竭的重要性由以下统计数据来表征：至少有 500 万 美国有250万人患有心力衰竭，需要住院治疗，超过50万人需要住院治疗 每年都会被诊断出患有心力衰竭。因此，这项研究与国家的使命高度契合。 心肺血液研究所致力于增强心脏病患者或有心脏病风险的人的健康 这样他们就能活得更久、生活更充实。 CRT 涉及植入先进的起搏器/除颤器 连接到心脏中的三根电线，旨在使不均匀泵血的心脏更同步地收缩 并且有效。尽管 CRT 对许多患者非常有益，但无反应率通常为 35-50% 当植入物不通过成像引导时，通常是因为起搏线的定位不理想 关于疤痕和机械激活。在 K23 颁奖期间，PI 演示了 MRI 表征如何 通过后期钆增强和 DENSE 应变（受激位移编码）来消除疤痕 Echoes)方法以前可用于确定最佳起搏部位，但直接MRI评估效果 CRT 后 LV 重塑的 LV 起搏部位直到最近才成为可能，当时新一代 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 提供的信息非常有价值，因为它可以提供有关以下方面的高度详细且可重复的数据： LV 结构和功能使用针对应变、体积、壁厚、同步和优化的脉冲序列 瘢痕。在这项研究中，CRT 后 MRI 结果将与 CRT 前 MRI 结果进行比较，以显示左室如何 起搏导线相对于机械激活的位置和疤痕会改变 CRT 后的左室重塑，并提供 关于左心室导联位置和心脏疤痕之间最佳空间关系的其他见解。核磁共振成像 结果将与超声心动图结果进行比较，研究结果有望证明这些结果如何 成像方式可以一起使用，以造福 CRT 患者。我们将招募 40 名 CRT 患者，他们将 进行心脏 MRI、超声心动图、心肺运动测试、症状评估和实验室检查 CRT 之前和之后 6 个月进行测试。该项目预计将对该领域产生重大影响并导致 CRT 实施方面的重要改进。这项工作还将促进 PI 的进步 通过为 MRI 引导的 CRT 临床试验的后续工作提供重要数据来保持独立性 开发基于左心室起搏导线放置的 CRT 后左心室重塑的计算模型。 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