Comprehensive analysis of endocardial strain using 4DCT data

利用4DCT数据综合分析心内膜应变

基本信息

批准号：
9910485
负责人：
Gabrielle M. Colvert
金额：
$ 3.79万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN DIEGO
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-02-01 至 2023-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9910485
关键词：
3-Dimensional Achievement Address Adult Age Algorithms Anatomy Aortic Valve Stenosis Bioprosthesis device Blood Cardiac Cardiac Surgery procedures Cardiomyopathies Catheters Clinical Clinical Trials Confidence Intervals Consumption Data Devices Diagnosis Disease Dose Drops EFRAC Echocardiography Eligibility Determination Endocardium Evaluation Growth Heart Heart Diseases Heart Rate Heart failure Individual Intervention Left Left Ventricular Dysfunction Left Ventricular Ejection Fraction Left Ventricular Function Left Ventricular Remodeling Left atrial structure Life Magnetic Resonance Imaging Manuals Maps Measurement Measures Medical Methods Mitral Valve Mitral Valve Insufficiency Modality Modeling Modernization Myocardial Myocardial dysfunction Myocardium Noise Normal Statistical Distribution Operative Surgical Procedures Outcome Patients Physiology Play Positioning Attribute Procedures Process Reporting Resolution Risk Role Rotation Shapes Signal Transduction Spatial Distribution Stroke Volume Surface Symptoms System Techniques Technology Time Tissues UPK3 gene Ventricular Ventricular Remodeling Visualization aortic valve replacement base cohort comorbidity contrast enhanced detector experimental study fitness heart function high risk implantation improved improved outcome minimally invasive mitral valve replacement mortality non-invasive imaging older patient patient stratification post intervention prognostic reconstruction repaired surgical risk temporal measurement tool valve replacement

项目摘要

Project Summary Minimally invasive transcather-based procedures have emerged over the past decade as a therapy for selected patients with valvular disease as an alternative to riskier open-heart surgery, particularly in patients with high surgical risk due to multiple comorbidities. As the technology improves and successful clinical outcomes increase, lower-risk patients are likely to be eligible for these procedures as demonstrated by recent clinical trials for transcather aortic valve replacement. Noninvasive imaging, which has supported the growth of transcather interventions by providing excellent preprocedural planning, could also become useful for stratifying patients based on quantifiable prognostic parameters. For example, transcatheter mitral valve replacement (TMVR) is a relatively new minimally invasive procedure to treat mitral regurgitation (MR); however, its effect on left ventricular (LV) function has not yet been characterized. In addition, patients with secondary MR as a result of left ventricular remodeling due to ischemic or idiopathic cardiomyopathy can have a large portion of their myocardium which is already dysfunctional which requires regional characterization of LV function. The proposed project aims to evaluate the net effect of MR and implantation of the bioprosthetic valve on LV function by identifying akinetic, dyskinetic, hypokinetic and normal regions of myocardium before and 1-month post minimally invasive valve replacement using noninvasive single heartbeat 4DCT-derived metrics. It is hypothesized that the fraction and spatial distribution of normal vs. abnormal tissue will correlate with the ability of the LV to recover post intervention. Regional maps of endocardial longitudinal strain, circumferential strain, and rotation will be compared to traditional global metrics such as stroke volume and ejection fraction. In addition, we will investigate the effect of the position of the bioprosthetic mitral valve device and anchoring system upon the remodeling process of the LV by performing statistical shape modeling pre and post procedure. In order to characterize regional myocardial function as normal or abnormal with estimated confidence intervals, the precision of the 4DCT-derived measurement tools will be quantified. This project aims to evaluate the effect of spatial resolution, temporal resolution, the signal-to-noise ratio, and the patient’s heart rate on the precision of myocardial function metrics. In addition, the proposed 4DCT-derived metrics will be validated in subjects who undergo both MRI tagging and 4DCT exams within the same day.

项目概要在过去的十年里，基于微创经导管的手术已经出现，作为特定疾病的治疗方法。患有瓣膜病的患者作为风险较大的心脏直视手术的替代方案，特别是对于患有高风险的患者随着技术的进步和成功的临床结果，多种合并症带来的手术风险。最近的临床试验表明，越来越多的低风险患者可能有资格接受这些手术用于经导管主动脉瓣置换术的无创成像，支持了经导管的发展。通过提供出色的术前计划进行干预也可能对患者分层有用例如，经导管二尖瓣置换术 (TMVR) 是一种基于可量化的预后参数的方法。治疗二尖瓣反流（MR）的相对较新的微创手术；然而，它对左心室的影响； (LV) 功能尚未被表征，此外，由于左心室而导致继发性 MR 的患者。由于缺血性或特发性心肌病导致的心肌重构可能会导致很大一部分心肌已经功能失调，需要对左室功能进行区域表征。拟议项目旨在评估 MR 和植入生物瓣膜对左心室的净效应通过识别术前和 1 个月后心肌的运动不能、运动障碍、运动减退和正常区域来评估功能使用无创单心跳 4DCT 衍生指标进行微创瓣膜置换术后。排除正常组织与异常组织的比例和空间分布与能力相关 LV 恢复干预后心内膜纵向应变、周向应变的区域图。和旋转将与传统的全局指标（例如每搏输出量和射血分数）进行比较。我们将研究生物二尖瓣装置和锚定系统的位置对通过在程序前后执行统计形状建模来进行 LV 的重塑过程。为了用估计的置信区间来表征局部心肌功能正常或异常， 4DCT 衍生测量工具的精度将被量化该项目旨在评估其效果。空间分辨率、时间分辨率、信噪比和患者心率对精度的影响此外，所提出的 4DCT 衍生指标将在受试者中进行验证。在同一天内接受 MRI 标记和 4DCT 检查。