4D Flow Cardiac Magnetic Resonance FOR Post Myocardial Infarction left ventricular thrombus

4D 血流心脏磁共振检查心肌梗死后左心室血栓

• 批准号: 9761241
• 负责人: Philip Angelo Corrado
• 金额: $ 3.33万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-01 至 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9761241
• 关键词: 3-Dimensional; 3D Print; 4D MRI; Acute myocardial infarction; Age; Aneurysm; Anticoagulation; Apical; Atrial Fibrillation; Blood; Blood Volume; Blood flow; Cardiac; Cardiovascular Diseases; Cardiovascular system; Characteristics; Chest; Clinical Data; Complex; Complication; Data; Data Set; Detection; Development; Event; Fostering; Functional disorder; Funding; Future; Gender; Goals; Gold; Heart Atrium; Heart Rate; Hemorrhage; Heterogeneity; Hybrids; Image; Image Analysis; Imaging Techniques; Impairment; In Vitro; Investigation; Kinetics; Lead; Left; Left Ventricular Ejection Fraction; Left ventricular structure; Link; Location; Magnetic Resonance; Magnetic Resonance Imaging; Measures; Mentors; Methods; Myocardial; Myocardial Infarction; Myocardial Reperfusion; Noise; Patient-Focused Outcomes; Patients; Pattern; Phase; Physics; Physiologic pulse; Physiological; Positioning Attribute; Printing; Problem Solving; Pulsatile Flow; Pump; Qualifying; Radial; Reference Standards; Request for Proposals; Research; Research Personnel; Residual state; Resolution; Risk; Scanning; Scheme; Stroke; Techniques; Testing; Thrombosis; Thrombus; Time; Training; Uncertainty; Validation; Velocimetries; Ventricular; Weight; Work; base; career; clinical care; cohort; high risk; image reconstruction; imaging approach; improved; improved outcome; in vivo; indexing; insight; interest; myocardial infarct sizing; novel; optical imaging; particle; skills; spatiotemporal; stem; tool; vector

Project Summary/Abstract Left ventricular thrombus (LVT) provides a substrate for embolic events and a rationale for anticoagulation. De- spite advances in coronary reperfusion, LVT remains common after ST elevation myocardial infarction (MI)– occurring in up to 1 in 5 patients with MI involving the LV apex. Predictors of LVT are limited, as evidenced by data that over half of cases occur without marked global LV dysfunction or aneurysm. Uncertainty as to who will develop LVT may explain clinical data that have shown anticoagulation to increase bleeding without decreasing stroke in seemingly at risk post-MI groups. Given the seriousness of stroke and bleeding conferred by LVT and its treatment, improved understanding of LVT is of major importance for the over quarter million people in the U.S. who sustain ST elevation MI each year. Cardiac magnetic resonance (CMR) imaging provides a highly accurate means to identify LVT, but current approaches are limited to predict in whom LVT will occur. This study is predicated on the hypothesis that LVT formation stems from altered LV blood flow and its determinants. To test this, LV blood flow will be quantified via volumetric time resolved “4D flow MRI” - a new method that can measure time-resolved, volumetric velocity vectors in vivo. We will develop a novel imaging approach for accurate assessment of LV flow impairment in in the context of MI. Aim 1 will develop new MRI methods that can be widely applied to quantify left ventricular stasis (low velocities). Specifically, a targeted 4D flow MRI pulse sequence (via radial stack-of-stars acquisition and dual velocity encoding) will be developed to achieve directed flow assessment of the LV with sensitivity to low velocities. Aim 2 will validate the new method: the new targeted acquisition will be compared with conventional full-chest acquisition for similarity to a reference standard (via optical imaging in vitro) or for repeatability in vivo. Aim 3 will test LV flow indices in a pilot cohort of MI patients to evaluate whether apical stasis (regional flow velocity, kinetic energy, residual blood volumes) post-MI is associated with LVT. The project sponsors and collaborators have a track record in successful translational CMR research and MRI physics, uniquely qualifying them to mentor on the proposed work. The novel information to be gained from this research has potential to impact clinical care by more precisely identifying post-MI flow patterns associated with LVT, thereby setting up future trials to test these parameters as predictors of LVT. The skills gained by the PI during this project will position him strongly for a successful independent research career in cardiovascular MRI.

项目摘要/摘要 左心室血栓（LVT）为栓塞事件提供了底物和抗凝作用的基本原理。 de ST升高心肌梗塞（MI） - 在5例MI患者中，最多有1例涉及LV Apex。 LVT的预测因子有限，如 超过一半的情况发生的数据没有明显的全局LV功能障碍或动脉瘤。关于谁会的不确定性 开发LVT可能解释了临床数据，这些数据显示抗凝可增加出血而不减少出血 在MI后群体中，中风似乎处于危险之中。鉴于LVT和 它的治疗方法，对LVT的了解提高了，对于超过24万人来说， 美国每年维持ST Hevation MI的美国。心脏磁共振（CMR）成像提供了高度 准确的识别LVT的方法，但是当前的方法仅限于预测将发生谁的LVT。这项研究 可以预测以下假设：LVT形成植物的LV血流及其决定剂的变化。到 测试这一点，LV血流将通过体积时间分析的“ 4D流MRI”来量化 - 一种可以的新方法 测量体内时间分辨的体积速度向量。我们将开发一种新颖的成像方法 在MI的背景下，准确评估LV流量损伤。 AIM 1将开发新的MRI方法 可以广泛应用以量化左心室滞留（低速速度）。具体而言，有针对的4D流MRI脉冲 将开发序列（通过径向堆栈的采集和双速度编码）来实现定向 对低速敏感的LV的流量评估。 AIM 2将验证新方法：新的目标 将收购与常规全胸收购进行比较，以与参考标准相似（通过 体外的光学成像或体内可重复性。 AIM 3将测试MI患者的驾驶员队列中的LV流量指数 评估顶端停滞（区域流速度，动能，残留血量）是否是MI 与LVT相关。项目发起人和合作者在成功的翻译CMR方面具有往绩记录 研究和MRI物理学，将它们独特地限定为指导拟议的工作。新的信息到 从这项研究中获得的可能会通过更精确地识别MI后流量来影响临床护理 与LVT相关的模式，从而设立了未来的试验，以测试这些参数作为LVT的预测指标。这 PI在此项目中获得的技能将使他在成功的独立研究职业中强烈地定位 在心血管MRI中。