Ferumoxytol-Enhanced Cardiac MRI for Ischemic Heart Disease

Ferumoxytol 增强心脏 MRI 治疗缺血性心脏病

基本信息

批准号：
9973771
负责人：
Kim-Lien T Nguyen
金额：
$ 77.04万
依托单位：
UNIVERSITY OF CALIFORNIA LOS ANGELES
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：
2020-07-01 至 2025-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/9973771
关键词：
Adenosine Adult Affect Anatomy Angiography Autopsy Beds Biodistribution Blood Vessels Blood Volume Blood capillaries Blood flow Bolus Infusion Cardiac Cardiovascular system Catheterization Cause of Death Chronic Chronic Kidney Failure Clinical Clinical Management Contrast Media Coronary Defect Diagnosis Diagnostic tests Disease Electric Capacitance Event Family suidae Future Gadolinium Goals Health Hyperemia Image Impairment Infarction Infrastructure Intervention Intravenous Ionizing radiation Iron Iron deficiency anemia Ischemia Kidney Kidney Diseases Kidney Failure Kidney Transplantation Kinetics Magnetic Resonance Magnetic Resonance Imaging Metabolic Methods Microvascular Dysfunction Morbidity - disease rate Morphologic artifacts Myocardial Myocardial Infarction Myocardial Ischemia Myocardial perfusion Myocardium Nephrogenic Systemic Fibrosis Organ Patients Performance Perfusion Perfusion Weighted MRI Pharmaceutical Preparations Population Positron-Emission Tomography Prevalence Property Protocols documentation Public Health Radiation Recovery Recurrence Relaxation Renal function Resistance Resolution Rest Risk Safety Signal Transduction Stress Stress Tests Techniques Testing Time Tissue Viability Tissues Vascular blood supply Vasodilation Work base clinical translation contrast enhanced cost effective density diagnostic accuracy experience ferumoxytol high risk hypoperfusion imaging approach imaging biomarker imaging detection indexing kidney dysfunction mortality nephrotoxicity pressure recruit side effect stress state

项目摘要

Project Summary Ischemic heart disease (IHD) and chronic kidney disease (CKD) are frequent bedfellows, but IHD as the leading cause of death in this population is under-diagnosed. Although patients with CKD and post-renal transplant have the highest risk for IHD, reliable estimation of ischemic burden remains a challenge. Accurate quantification of ischemic burden is crucial for clinical management because invasive interventions may worsen kidney function. In patients with CKD, cardiovascular event rates increase significantly with increasing stage of CKD. Contrast-enhanced cardiac magnetic resonance imaging (MRI) is attractive due to the absence of ionizing radiation and its inherent ability to provide high spatial resolution images. But perfusion cardiac MRI for defining ischemia relies on the first-pass bolus of gadolinium, which has intrinsic technical shortcomings. Late gadolinium enhancement for viability is also dependent on gadolinium contrast kinetics. Both are less suitable for patients with CKD. In patients with renal failure, gadolinium-associated nephrogenic systemic fibrosis may be fatal and more recently, autopsy results in patients with normal kidney function support gadolinium accumulation in certain organs and tissues. Our goal is to test and validate a non-nephrotoxic, steady-state cardiac MRI strategy that overcomes many drawbacks of gadolinium-enhanced cardiac MRI to detect inducible ischemia and viability. We build upon our collective experience with ferumoxytol-enhanced MRI and ischemic heart disease. Because ferumoxytol is well-tolerated in patients with renal impairment and has broad clinical approval for intravenous treatment of iron deficiency anemia, if proven successful, our steady state stress cardiac MRI approach may also be valuable for other applications.

项目概要缺血性心脏病 (IHD) 和慢性肾脏病 (CKD) 是常见病，但 IHD 是最常见的疾病该人群的主要死亡原因未得到充分诊断。尽管患有 CKD 和肾后性肾病的患者移植发生 IHD 的风险最高，但可靠地估计缺血负荷仍然是一个挑战。准确的缺血负荷的量化对于临床管理至关重要，因为侵入性干预可能肾功能恶化。在 CKD 患者中，心血管事件发生率随着年龄的增长而显着增加 CKD 阶段。对比增强心脏磁共振成像 (MRI) 由于缺乏电离辐射及其提供高空间分辨率图像的固有能力。但灌注心脏MRI 定义缺血依赖于钆的首过推注，其具有固有的技术缺陷。后期钆对活力的增强也取决于钆对比动力学。两者都比较少适合慢性肾病患者。在肾功能衰竭患者中，钆相关的肾源性全身性纤维化可能是致命的，最近尸检结果显示肾功能正常的患者钆在某些器官和组织中积累。我们的目标是测试和验证无肾毒性、稳态心脏 MRI 策略克服了钆增强心脏 MRI 的许多缺点检测诱导性缺血和活力。我们以我们的集体经验为基础，使用非罗莫托增强 MRI 和缺血性心脏病。因为费鲁莫托在肾功能不全的患者中具有良好的耐受性，并且已获得广泛的临床批准用于静脉注射治疗缺铁性贫血，如果证明成功，我们的稳态应激心脏 MRI 方法对于其他应用也可能有价值。