3D Echocardiography to Improve Clinical Outcomes After Surgery for Ischemic Mitral Regurgitation

3D 超声心动图可改善缺血性二尖瓣反流手术后的临床结果

• 批准号: 9983127
• 负责人: Robert C Gorman
• 金额: $ 63.19万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-06-06 至 2023-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9983127
• 关键词: 3-Dimensional; Adoption; Adverse event; Affect; Age; Algorithms; American; Anatomy; Assessment tool; Clinical; Custom; Data; Data Set; Databases; Development; Failure; Funding; Goals; Heart failure; High Prevalence; Image; Incidence; Left; Left Ventricular Remodeling; Measures; Mitral Valve; Mitral Valve Insufficiency; Modeling; Myocardial Infarction; Operating Rooms; Operative Surgical Procedures; Outcome; Patients; Patients' Rooms; Pennsylvania; Population; Process; Randomized; Recurrence; Reporting; Risk; Risk Assessment; Risk stratification; Source; Stratification; Structure; Subgroup; Surgeon; Techniques; Three-Dimensional Echocardiography; Time; Two-Dimensional Echocardiography; Universities; Validation; Ventricular; adverse outcome; base; cohort; experience; feature extraction; follow-up; high risk; improved; innovation; mitral valve replacement; novel strategies; patient subsets; prediction algorithm; prospective; randomized trial; recruit; repaired; temporal measurement; tool; treatment strategy; trial comparing; valve replacement

Ischemic mitral regurgitation (IMR) is a consequence of adverse left ventricular (LV) remodeling after myocardial infarction (MI). As a result of a lack of conclusive data regarding the best surgical approach (valve repair vs. replacement) the Cardiothoracic Surgical Trials Network (CTSN) conducted two multicenter, randomized trials to evaluate the relative benefits of these two surgical approaches to IMR. Unfortunately, the CTSN IMR trials did not establish the optimal surgical approach. Results of the CTSN Severe IMR trial demonstrated no difference in LV reverse remodeling between repair and replacement groups. However, subgroup analysis highlighted the negative implications of recurrent IMR. IMR recurred much more frequently in the repair group, resulting in more heart-failure related adverse events. Importantly, repair patients with recurrent IMR had no reduction in LV volume, while repair patients without recurrence experienced LV volume reduction that was superior to patients having valve replacement. These results strongly suggest that a patient- specific approach to surgical treatment guided by preoperative imaging-based risk stratification that is predictive of recurrent IMR would be useful for optimizing surgical results. During the initial funding period of this project, our group at the University of Pennsylvania (Penn) demonstrated that measures of mitral leaflet tethering derived from pre-operative 3D echocardiography (3DE) and a custom valve modeling algorithm accurately predicted the recurrence of IMR after valve repair. The goal of this competitive renewal is to provide conclusive evidence that pre- operative risk-based repair/replacement stratification using 3DE significantly reduces recurrent IMR and, more importantly, improves LV remodeling, long-term clinical outcomes and survival for patients with IMR. We propose to use two existing data sets to achieve our intended goal expeditiously and at limited expense: (1) as part of the initially funded project we have recruited 85 patients with IMR that have had pre-repair 3DE and have been followed prospectively to assess for recurrence of IMR. We propose to continue this recruitment at Penn to enlarge our cohort to 120 patients to allow further development and validation of an optimal predictive algorithm for recurrent IMR after MV repair; (2) the CTSN IMR trials data base which includes 551 IMR patients randomized to either MV repair (n=276), MV replacement (n=125) or CABG alone (n=150); 180 of the CTSN cohort have had pre-operative 3DE. All CTSN patients also have extensive echocardiographic and long-term clinical follow-up, which is ongoing. In Aim 1 we will establish the optimal 3DE-based predictive algorithm for recurrent IMR from candidate algorithms developed from continued recruitment of IMR repair patients at Penn. In Aim 2 we will assess the benefit of using the ideal predictive algorithm from Aim 1 on the incidence of recurrent IMR and long-term clinical outcomes in the CTSN IMR Trials data base. Finally, in Aim 3 we will develop a technique for automatic 3D segmentation and geometric modeling of the mitral valve and LV to allow for real-time risk-based repair/replacement stratification in the operating room for patients having surgery for IMR.

缺血性二尖瓣反流（IMR）是不良左心室（LV）重塑后的结果 心肌梗塞（MI）。由于缺乏有关最佳手术方法的结论性数据（阀门） 维修与更换）心胸外科手术试验网络（CTSN）进行了两个多中心 随机试验评估这两种手术方法的相对益处。不幸的是， CTSN IMR试验未建立最佳手术方法。 CTSN严重IMR试验的结果 证明修复组和替换组之间的LV反向重塑没有差异。然而， 亚组分析强调了经常性IMR的负面影响。 IMR更频繁地重复 在维修组中，导致更多相关的相关不良事件。重要的是，维修患者 复发性IMR的LV体积没有减少，而没有复发的维修患者经历了LV体积 减少优于替代瓣膜的患者。这些结果强烈表明患者 通过基于术前成像的风险分层为指导的手术治疗的特定方法 预测复发性IMR将有助于优化手术结果。在最初的资金期间 项目，我们的宾夕法尼亚大学（PENN）的小组表明，二尖瓣绑带的措施得出 从术前3D超声心动图（3DE）和自定义阀门建模算法准确预测 阀修复后IMR的复发。这种竞争性更新的目的是提供确定的证据 使用3DE的基于操作风险的维修/替换分层显着降低了经常性IMR，更多 重要的是，IMR患者的LV重塑，长期临床结果和存活率提高。我们建议 使用两个现有数据集以迅速而有限的费用实现我们的预期目标：（1）作为最初的一部分 资助的项目我们已招募了85例IMR患者，他们已经进行了3D的修复之前，并且已遵循 预期评估IMR的复发。我们建议继续在宾夕法尼亚 120名患者允许进一步开发和验证MV之后的经常性IMR的最佳预测算法 维修; （2）CTSN IMR试验数据库，其中包括551名IMR患者，随机分配给MV修复（n = 276），MV 单独替换（n = 125）或CABG（n = 150）; CTSN队列的180个具有术前3DE。所有CTSN患者 还具有广泛的超声心动图和长期临床随访。在目标1中，我们将建立 来自候选算法的复发性IMR的最佳3DE预测算法从 继续招募宾夕法尼亚州IMR修复患者。在AIM 2中，我们将评估使用理想的好处 AIM 1的预测算法对CTSN的复发性IMR和长期临床结果的发生率 IMR试验数据库。最后，在AIM 3中，我们将开发一种用于自动3D细分的技术和 二尖瓣和LV的几何建模，以实时基于风险的维修/更换 手术室的手术室内分层。

项目成果

Segmentation of the Aortic Valve Apparatus in 3D Echocardiographic Images: Deformable Modeling of a Branching Medial Structure.

• DOI: 10.1007/978-3-319-14678-2_20
• 发表时间: 2015-01-01
• 期刊: Statistical atlases and computational models of the heart. STACOM (Workshop)
• 作者: Pouch AM;Tian S;Takabe M;Wang H;Yuan J;Cheung AT;Jackson BM;Gorman JH 3rd;Gorman RC;Yushkevich PA
• 通讯作者: Yushkevich PA

Invited Commentary.

特邀评论。

• DOI: 10.1016/j.jvs.2008.11.103
• 发表时间: 2009
• 期刊: Journal of vascular surgery
• 影响因子: 4.3
• 作者: Dardik,Alan

Antioxidant enzymes reduce DNA damage and early activation of valvular interstitial cells in aortic valve sclerosis.

• DOI: 10.1161/atvbaha.112.300177
• 发表时间: 2013-02
• 期刊: Arteriosclerosis, thrombosis, and vascular biology
• 作者: Branchetti E;Sainger R;Poggio P;Grau JB;Patterson-Fortin J;Bavaria JE;Chorny M;Lai E;Gorman RC;Levy RJ;Ferrari G
• 通讯作者: Ferrari G

Spatiotemporal Segmentation and Modeling of the Mitral Valve in Real-Time 3D Echocardiographic Images.

• DOI: 10.1007/978-3-319-66182-7_85
• 发表时间: 2017-09
• 期刊: Medical image computing and computer-assisted intervention : MICCAI ... International Conference on Medical Image Computing and Computer-Assisted Intervention
• 作者: Pouch AM;Aly AH;Lai EK;Yushkevich N;Stoffers RH;Gorman JH 4th;Cheung AT;Gorman JH 3rd;Gorman RC;Yushkevich PA
• 通讯作者: Yushkevich PA

Novel In Vitro Test Systems and Insights for Transcatheter Mitral Valve Design, Part I: Paravalvular Leakage.

• DOI: 10.1007/s10439-018-02154-4
• 发表时间: 2019-03
• 期刊: Annals of biomedical engineering
• 影响因子: 3.8
• 作者: Pierce EL;Sadri V;Ncho B;Kohli K;Shah S;Yoganathan AP
• 通讯作者: Yoganathan AP