True 4DCT for Quantifying LV Dyssynchrony and Function for Targeting LV Lead Location in CRT

真正的 4DCT 用于量化 LV 不同步和功能，用于在 CRT 中定位 LV 导联位置

基本信息

批准号：
10323015
负责人：
ELLIOT R MCVEIGH
金额：
$ 70.3万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN DIEGO
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-01-15 至 2023-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10323015
关键词：
3D Print Anatomy Blinded Cardiac Cicatrix Clinical Trials Data Dependence Development Dose EKG QRS Complex Echocardiography Eye Female Functional disorder Gadolinium Geometry Goals Heart Heart failure Human Image Image Analysis Imaging Phantoms Impairment Laboratories Lead Left Location Magnetic Resonance Imaging Manuals Maps Measurement Measures Mechanics Medical Methods Modeling Morphologic artifacts Motion Myocardial Outcome Patient Schedules Patients Phase Physicians Physiological Procedures Process Reproducibility Research Resolution Roentgen Rays Rotation Scheme Series Site Structure System Techniques Testing Time Tissues Validation Vendor Work cardiac magnetic resonance imaging cardiac resynchronization therapy digital experimental study four-dimensional computed tomography heart imaging human data imaging modality improved male novel physical model predicting response reconstruction responders and non-responders response temporal measurement

项目摘要

Project Abstract/Summary Cardiac resynchronization therapy (CRT) is a proven treatment for patients with impaired LV function and a wide QRS complex. However, approximately 1/3 of patients do not respond to CRT because of suboptimal LV lead placement yielding persistent dyssynchrony. No large clinical trials have demonstrated that image derived parameters can differentiate responders from non-responders. Significant intra-observer and inter-vendor differences in parameters derived from echocardiography have stimulated the search for alternative imaging methods. We and others have demonstrated that cardiac MRI is an excellent method for measuring mechanical dyssynchrony and identifying regions of scar through late gadolinium enhancement; hence, MRI could possibly guide LV lead placement to avoid non-viable tissue and target regions of late mechanical activation. Unfortunately, a large number of patients considered for CRT have existing pacing systems, or do not have access to advanced MRI laboratories, severely limiting the possibility of MR guidance. The solution: Our recent development of a novel high resolution LV function mapping technique called SQUEEZ now allows us to identify viable LV pacing targets from 4DCT data with a single heartbeat exam. However, the accuracy and precision of 4DCT for measuring dyssynchrony in the LV is unknown and it is clear that motion artifacts in 4DCT may compromise temporal measurements if left uncorrected. In order to achieve the best temporal resolution possible, we propose a novel motion correction scheme called “ResyncCT” which reduces the motion artifacts generated by CT gantry rotation. Our preliminary results lead us to the following hypothesis: the analysis of “ResyncCT” motion-corrected 4DCT images with SQUEEZ can be used to target optimal pacing sites to correct LV dyssynchrony with CRT. In order to validate this hypothesis, we will optimize cardiac cine 4DCT acquisitions and ResyncCT motion compensated reconstruction for measuring LV dyssynchrony, and we will optimize and validate SQUEEZ in highly realistic anthropomorphic 3D printed phantoms and in CRT patients. Ultimately, our accuracy in predicting response to CRT will be tested retrospectively in a series of CRT patients in whom 4DCT data was obtained prior to their CRT procedure. For each patient, by analyzing their 4DCT data after ResyncCT and SQUEEZ processing, we will compute a novel “Lead Placement Score” at the site of their LV lead. We will test the hypothesis that the Lead Placement Score is significantly different in the patients who respond (decrease in End-Systolic Volume > 15% at 6 months) than in those patients who do not respond to CRT.

项目摘要/总结心脏再同步治疗 (CRT) 是一种经过验证的治疗方法，适用于左心室功能受损且心脏功能受损的患者。然而，大约 1/3 的患者由于 LV 不理想而对 CRT 没有反应。引线放置会产生持续的不同步。没有大型临床试验证明图像衍生。参数可以区分显着的观察者内部和供应商之间的响应者和非响应者。超声心动图参数的差异刺激了对替代成像的探索我们和其他人已经证明心脏 MRI 是一种极好的测量方法。机械不同步并通过后期钆增强识别疤痕区域，因此，MRI；可能会指导 LV 导线放置，以避免无活性组织和晚期机械损伤的目标区域不幸的是，大量考虑接受 CRT 的患者已有起搏系统，或者没有。无法进入先进的 MRI 实验室，严重限制了 MR 指导的可能性。我们最近开发了一种名为 SQUEEZ 的新型高分辨率 LV 功能映射技术，现在允许我们通过一次心跳检查从 4DCT 数据中确定可行的左心室起搏目标。用于测量 LV 不同步的 4DCT 精度尚不清楚，但很明显，LV 中的运动伪影如果不进行校正，4DCT 可能会影响时间测量以实现最佳时间。分辨率可能，我们提出了一种称为“ResyncCT”的新颖运动校正方案，该方案减少了 CT 机架旋转产生的运动伪影我们的初步结果得出以下假设：使用 SQUEEZ 对“ResyncCT”运动校正 4DCT 图像进行分析可用于确定最佳目标纠正 LV 与 CRT 不同步的起搏部位为了验证这一假设，我们将进行优化。用于测量 LV 的心脏电影 4DCT 采集和 ResyncCT 运动补偿重建不同步，我们将在高度逼真的拟人化 3D 打印中优化和验证 SQUEEZ 最终，我们预测 CRT 反应的准确性将得到检验。回顾性地对一系列 CRT 患者进行了回顾性研究，这些患者在 CRT 手术之前获得了 4DCT 数据。每个患者，通过在 ResyncCT 和 SQUEEZ 处理后分析他们的 4DCT 数据，我们将计算一个新的在他们的 LV 线索站点上的“线索放置分数”我们将测试线索放置分数的假设。有反应的患者（6 个月时收缩末期容量减少 > 15%）与那些对 CRT 没有反应的患者。

项目成果

期刊论文数量（5）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Precise measurement of coronary stenosis diameter with CCTA using CT number calibration.

使用 CT 数校准通过 CCTA 精确测量冠状动脉狭窄直径。

DOI：
发表时间：
2019-12
期刊：
影响因子：
3.8
作者：
Chen, Zhennong;Contijoch, Francisco;Schluchter, Andrew;Grady, Leo;Schaap, Michiel;Stayman, Web;Pack, Jed;McVeigh, Elliot
通讯作者：
McVeigh, Elliot

Four-dimensional computed tomography of the left ventricle, Part II: Estimation of mechanical activation times.

左心室四维计算机断层扫描，第二部分：机械激活时间的估计。

DOI：
发表时间：
2022-04
期刊：
影响因子：
3.8
作者：
Manohar, Ashish;Pack, Jed D;Schluchter, Andrew J;McVeigh, Elliot R
通讯作者：
McVeigh, Elliot R

Four-dimensional computed tomography of the left ventricle, Part I: Motion artifact reduction.

左心室四维计算机断层扫描，第一部分：运动伪影减少。

DOI：
发表时间：
2022-07
期刊：
影响因子：
3.8
作者：
Pack, Jed D;Manohar, Ashish;Ramani, Sathish;Claus, Bernhard;Yin, Zhye;Contijoch, Francisco J;Schluchter, Andrew J;McVeigh, Elliot R
通讯作者：
McVeigh, Elliot R

Vascular Landmark-Based Method for Highly Reproducible Measurement of Left Atrial Appendage Volume in Computed Tomography.

基于血管标志的方法，用于在计算机断层扫描中高度重复地测量左心耳体积。

DOI：
发表时间：
2019
期刊：
影响因子：
0
作者：
Schluchter, Andrew;Jan, Chelsea;Lowe, Katherine;Vigneault, Davis M;Contijoch, Francisco;McVeigh, Elliot R
通讯作者：
McVeigh, Elliot R

Computed Tomography-Guided Risk Assessment in Percutaneous Lead Extraction.

计算机断层扫描引导经皮铅提取的风险评估。