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) 是左心室 (LV) 重构后不良的结果 心肌梗塞（MI）。由于缺乏关于最佳手术方法（瓣膜）的结论性数据 修复与替换）心胸外科试验网络 (CTSN) 进行了两次多中心、 评估这两种手术方法对 IMR 的相对益处的随机试验。不幸的是， CTSN IMR 试验并未确定最佳手术方法。 CTSN 严重 IMR 试验的结果 证明修复组和置换组之间的左心室逆重塑没有差异。然而， 亚组分析强调了复发性 IMR 的负面影响。 IMR 复发频率更高 在修复组中，导致更多与心力衰竭相关的不良事件。重要的是，修复患者 复发性 IMR 患者的左室容积没有减少，而未复发的修复患者的左室容积有所减少 减少的效果优于接受瓣膜置换术的患者。这些结果强烈表明患者—— 以术前基于影像学的风险分层为指导的具体手术治疗方法 预测复发性 IMR 将有助于优化手术结果。在本次初始资助期间 项目中，我们宾夕法尼亚大学 (Penn) 的团队证明了二尖瓣瓣叶栓系的测量方法 根据术前 3D 超声心动图 (3DE) 和定制瓣膜建模算法准确预测了 瓣膜修复后 IMR 复发。此次竞争性更新的目的是提供确凿的证据，证明 使用 3DE 进行基于手术风险的修复/更换分层可显着减少复发性 IMR，并且更多 重要的是，可以改善 IMR 患者的左室重塑、长期临床结果和生存率。我们建议 使用两个现有数据集以有限的费用快速实现我们的预期目标：（1）作为最初的一部分 资助项目我们招募了 85 名 IMR 患者，他们已经进行了预修复 3DE 并进行了随访 前瞻性地评估 IMR 的复发情况。我们建议继续在宾夕法尼亚大学进行招募，以扩大我们的队伍 120 名患者可以进一步开发和验证 MV 后复发 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，随机接受 MV 修复 (n=276)、MV 置换术 (n=125) 或单独 CABG (n=150)； CTSN 队列中有 180 人患有术前 3DE。所有 CTSN 患者 还进行了广泛的超声心动图和长期临床随访，目前正在进行中。在目标 1 中，我们将建立 基于 3DE 的最佳循环 IMR 预测算法，来自于以下开发的候选算法 宾夕法尼亚大学继续招募 IMR 修复患者。在目标 2 中，我们将评估使用理想模型的好处 目标 1 中关于 CTSN 中复发性 IMR 发生率和长期临床结果的预测算法 IMR 试验数据库。最后，在目标 3 中，我们将开发一种自动 3D 分割和 二尖瓣和左心室的几何建模可实现基于风险的实时修复/更换 对接受 IMR 手术的患者在手术室进行分层。

项目成果

Invited commentary.

特邀评论。

• 发表时间: 2014-05
• 作者: Gorman 3rd, Joseph H;Gorman, Robert C
• 通讯作者: Gorman, Robert C

Peak wall stress predicts expansion rate in descending thoracic aortic aneurysms.

峰值壁应力预测胸降主动脉瘤的扩张率。

• 发表时间: 2013-02
• 作者: Shang, Eric K;Nathan, Derek P;Sprinkle, Shanna R;Vigmostad, Sarah C;Fairman, Ronald M;Bavaria, Joseph E;Gorman, Robert C;Gorman 3rd, Joseph H;Chandran, Krishnan B;Jackson, Benjamin M
• 通讯作者: Jackson, Benjamin M

Atrial Dysfunction in Significant Atrial Functional Mitral Regurgitation: Phenotypes and Prognostic Implications.

显着心房功能性二尖瓣反流中的心房功能障碍：表型和预后意义。

• 发表时间: 2023-05
• 作者: Cramariuc, Dana;Alfraidi, Hassan;Nagata, Yasufumi;Levine, Robert A;van Kampen, Antonia;Andrews, Carl;Hung, Judy
• 通讯作者: Hung, Judy

Reply.

回复。

• 发表时间: 2018-07
• 作者: Bouma, Wobbe;Wijdh;Gorman 3rd, Joseph H;Gorman, Robert C
• 通讯作者: Gorman, Robert C

Fully Automated 3D Segmentation and Diffeomorphic Medial Modeling of the Left Ventricle Mitral Valve Complex in Ischemic Mitral Regurgitation.

缺血性二尖瓣反流中左心室二尖瓣复合体的全自动 3D 分割和微分内侧建模。

• 发表时间: 2022-08
• 影响因子: 10.9
• 作者: Aly, Ahmed H;Khandelwal, Pulkit;Aly, Abdullah H;Kawashima, Takayuki;Mori, Kazuki;Saito, Yoshiaki;Hung, Judy;Gorman 3rd, Joseph H;Pouch, Alison M;Gorman, Robert C;Yushkevich, Paul A
• 通讯作者: Yushkevich, Paul A