Detection of Left Ventricular Dyssynchrony by Cross-Correlation Analysis

通过互相关分析检测左心室不同步

• 批准号: 7586809
• 负责人: JOHN N OSHINSKI
• 金额: $ 19.38万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-03-15 至 2012-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7586809
• 关键词: Acute; Admission activity; Artificial cardiac pacemaker; Cardiac; Cardiac Output; Clinical; Data; Data Set; Databases; Detection; Diagnosis; Diastole; EFRAC; EKG QRS Complex; Electrocardiogram; Heart; Heart failure; Hospitals; Image; Lead; Left; Measures; Mechanics; Methodology; Methods; Mitral Valve Insufficiency; Multi-Institutional Clinical Trial; Myocardial Contraction; Myocardial tissue; Myocardium; Outcome; Pacemakers; Patient Selection; Patients; Performance; Pharmaceutical Preparations; Publishing; Receiver Operating Characteristics; Refractory; Relaxation; Reporting; Research Personnel; Sensitivity and Specificity; Severities; Surface; Testing; Time; Tissues; United States; Ventricular; Ventricular Function; Ventricular Remodeling; base; computerized data processing; hemodynamics; implantation; improved; inclusion criteria; normal aging; novel; response; tool

DESCRIPTION (provided by applicant): In thirty percent of patients with severe, drug-refractory heart failure, regional timing of myocardial contraction and relaxation is dyssynchronous. This mechanical dyssynchrony leads to adverse ventricular remodelling, increased mitral regurgitation, and reduced ejection fraction. Cardiac resynchronization therapy (CRT) is a relatively new treatment for heart failure patients with dyssynchrony that results in both acute hemodynamic benefit as well as improved long-term outcome. Despite CRT showing benefits in many multi- center clinical trials, 30% of patients selected for CRT show no improvement by clinical or echocardiographic endpoints. This poor response rate may in part be explained by limitations of current methods to determine the presence and severity of dyssynchrony. To overcome the limitations of existing dyssynchrony parameters, we have developed a new mathematical method to calculate a temporal delay between two myocardial tissue velocity profiles acquired with tissue Doppler imaging (TDI). Our method utilizes a function to quantify either systolic, diastolic, or whole- cycle delays using TDI data collected throughout the cardiac cycle. The objectives of this study are to evaluate the ability of our method to: 1) quantify mechanical dyssynchrony in the heart, and 2) predict response to CRT. Preliminary data in a group of young, healthy, normal subjects (negative controls) and known responders to CRT (positive controls) indicate excellent sensitivity and specificity of the methodology. The central hypothesis of this study is that our method of determining dyssynchrony delays is more sensitive and specific in selecting patients who respond to CRT compared to currently utilized methods. To test the hypothesis, we will utilize an existing data set of from a large, multi-center CRT trial (PROSPECT trial). The specific aims of this project are: 1) Quantify systolic, diastolic and whole-cycle delays in a group on normal, aged-matched subjects (negative controls) and compare delay values in these subjects to delay values in a group known responders to CRT (positive controls). 2) Evaluate the ability of systolic, diastolic, and whole-cycle delays to predict response to CRT using an existing large, multi-center database of 260 patients. PUBLIC HEALTH RELEVANCE: We propose to develop and test a new method to improve selection of patients who will benefit from cardiac pacemaker implantation. The methodology uses signal processing methods based on echocardiographic image data. We will use images from an existing database of 260 subjects. The method would improve patient selection so only subjects who would benefit from pacemaker implantation would be identified, and all subjects who would benefit from a pacemaker would be identified.

描述（由申请人提供）：在患有严重的药物不良心力衰竭的患者中，有30％的患者，心肌收缩的区域时间和放松的区域时间障碍。这种机械性障碍会导致心室不良重塑，二尖瓣流体的增加和减少的射血分数。心脏重新同步疗法（CRT）是一种相对较新的治疗疗法，可导致急性血液动力学益处和改善的长期预后，可导致心力衰竭患者。尽管CRT在许多多个中心临床试验中显示出益处，但选择CRT的患者中有30％均未通过临床或超声心动图终点改善。这种较差的应答率可能部分通过当前方法的局限性来确定异议障碍的存在和严重性。为了克服现有的非同步参数的局限性，我们开发了一种新的数学方法来计算使用组织多普勒成像（TDI）获得的两个心肌组织速度谱之间的时间延迟。我们的方法利用一个函数来量化收缩期，舒张期或整个周期延迟，并在整个心脏周期中收集的TDI数据。这项研究的目的是评估我们方法的能力：1）量化心脏中的机械性异构性障碍，以及2）预测对CRT的反应。一组年轻，健康，正常受试者（阴性对照）和对CRT的已知反应者（阳性对照）中的初步数据表明该方法的灵敏度和特异性。这项研究的中心假设是，与当前使用的方法相比，我们确定异步延迟的方法更敏感和特异性。为了检验假设，我们将从大型多中心CRT试验中利用现有的数据集（Prospect试验）。该项目的具体目的是： 1）在正常，老年匹配的受试者（阴性对照组）的组中量化收缩，舒张期和全周期延迟，并比较这些受试者中的延迟值与CRT组已知响应者的延迟值（正对照）（正对照）。 2）评估使用现有的260名患者的现有大型多中心数据库来评估收缩期，舒张期和全周期延迟对CRT的反应。公共卫生相关性：我们建议开发和测试一种新方法，以改善将受益于心脏起搏器植入的患者的选择。该方法使用基于超声心动图图像数据的信号处理方法。我们将使用来自260个主题的现有数据库中的图像。该方法将改善患者的选择，因此只有从起搏器植入中受益的受试者才能确定，所有将从起搏器中受益的受试者都将被确定。