Noninvasive assessment of coronary endothelial function by multi-slice MRI

多层MRI无创评估冠状动脉内皮功能

• 批准号: 10456016
• 负责人: Michael Schaer
• 金额: $ 24.56万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-01 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10456016
• 关键词: 3-Dimensional; Acute Coronary Event; Anatomy; Area; Arteries; Attenuated; Award; Blood Vessels; Blood flow; Calibration; Cardiac; Cardiac Catheterization Procedures; Cardiovascular system; Catheterization; Cessation of life; Characteristics; Cine Magnetic Resonance Imaging; Clinical; Coronary; Coronary Arteriosclerosis; Coronary artery; Detection; Development; Diagnostic; Dilatation - action; Disease; Disease Progression; Endothelial Cells; Endothelium; Event; Exercise; Exhibits; Fatty acid glycerol esters; Freezing; Functional disorder; Future; Gold; Health; Heart; Heterogeneity; Image; Imaging Techniques; Impairment; Intervention; Isometric Exercise; Knowledge; Life; Location; Magnetic Resonance; Magnetic Resonance Imaging; Measurement; Measures; Mediating; Medical; Methods; Monitor; Myocardial Infarction; Nitric Oxide; Noise; Participant; Patients; Pericardial body location; Persons; Physiologic pulse; Physiology; Population; Reproducibility; Resolution; Rest; Risk; Rupture; Sample Size; Signal Transduction; Slice; Stenosis; Stress; Testing; Thick; Thinness; Time; Tissues; United States; Validation; Water; Work; anatomic imaging; clinical imaging; clinical practice; clinically relevant; constriction; data acquisition; design; disability; endothelial dysfunction; heart motion; imaging approach; imaging modality; in vivo; non-invasive imaging; novel; novel strategies; premature; prognostic; response; stressor; tool; treatment response; two-dimensional

Coronary artery disease (CAD) remains a leading and important cause of disability and premature death in the United States. Conventional clinical imaging characterizes coronary artery anatomy, but because most acute coronary events result from plaque rupture in regions previously exhibiting less than 50% luminal stenosis, current state-of-the-art anatomic imaging cannot predict where plaque progression and events will occur. A new approach is needed and evidence suggests that coronary endothelial function (CEF) imaging can fill this gap. CEF is considered a “barometer” of vascular health because endothelial release of nitric oxide in response to certain stressors is a defining characteristic of healthy vascular tissue that results in arterial dilatation and increased blood flow. Impaired endothelial nitric oxide release, or endothelial dysfunction, is a marker for sub-clinical disease, an independent predictor of future CAD progression and cardiac events, and responds favorably to beneficial medical interventions. Despite the well-established diagnostic and prognostic importance of CEF, it is rarely measured in clinical practice because it was mostly measured with invasive cardiac catheterization. We recently developed a noninvasive magnetic resonance imaging (MRI) means to quantify local CEF that combines 2-dimensional (2D) cine MRI with isometric handgrip exercise (IHE). The main limitation is that the 2D approach only allows CEF measurements at just two to four locations and therefore cannot characterize CEF in multiple arteries or regional heterogeneity present throughout a diseased coronary artery. The aims of our proposal are 1) to develop a new multi-slice MRI method that to assess CEF area changes along proximal to mid segments in all major coronary arteries; 2) to optimize and validate the proposed method’s ability to measure cross sectional areas by assessing both accuracy and precision; and 3) to validate the CEF measures from the proposed method against the noninvasive gold-standard including reproducibility testing in both healthy subjects and stable CAD patients. This work will provide a robust, noninvasive means to better and more comprehensively assess CEF, an independent predictor of future atherosclerotic progression and events, and barometer of response to therapy. Knowledge of accuracy, precision, and reproducibility values will enable us to design future studies investigating novel interventions and monitoring disease progression.

冠状动脉疾病（CAD）仍然是导致残疾和过早死亡的主要原因 美国传统的临床影像学表征了冠状动脉的解剖结构，但因为大多数是急性的。 冠状动脉事件区域是由先前表现出小于 50% 管腔狭窄的斑块破裂引起的， 目前最先进的解剖成像无法预测斑块进展和事件将发生的位置。 需要新的方法，证据表明冠状动脉内皮功能 (CEF) 成像可以填补这一空白 CEF 被认为是血管健康的“晴雨表”，因为内皮释放一氧化氮。 对某些压力源的反应是健康血管组织的一个决定性特征，导致动脉粥样硬化 扩张和血流量增加是内皮一氧化氮释放受损或内皮功能障碍的一种。 亚临床疾病的标志物，未来 CAD 进展和心脏事件的独立预测因子，以及 尽管有完善的诊断和预后，但对有益的医疗干预措施反应良好。 CEF 的重要性，但在临床实践中很少测量，因为它主要是通过有创测量的 我们最近开发了一种无创磁共振成像（MRI）方法。 结合二维 (2D) 电影 MRI 和等长握力练习 (IHE) 来量化局部 CEF。 主要限制是 2D 方法仅允许在两到四个位置进行 CEF 测量，并且 因此无法表征多条动脉中的 CEF 或整个患病区域中存在的区域异质性 我们建议的目标是 1) 开发一种新的多层 MRI 方法来评估 CEF。 沿所有主要冠状动脉近端到中段的面积变化；2) 优化和验证 所提出的方法通过评估准确度和精度来测量横截面积的能力；以及 3) 根据非侵入性黄金标准验证所提出方法的 CEF 措施，包括 这项工作将在健康受试者和稳定的 CAD 患者中进行可重复性测试。 更好、更全面地评估 CEF（未来的独立预测因子）的非侵入性方法 动脉粥样硬化进展和事件，以及治疗反应的晴雨表 准确性知识， 精确度和可重复性值将使我们能够设计未来的研究来调查新的干预措施 和疾病监测。