Exercise Stress Cardiac Magnetic Resonance

运动压力心脏磁共振

• 批准号: 7745974
• 负责人: Orlando Paul Simonetti
• 金额: $ 37.01万
• 依托单位: EXCMR, LTD
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-25 至 2011-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7745974
• 关键词: Achievement; Acoustics; Algorithms; American; Body Weight; Cardiac; Cardiovascular Diseases; Cardiovascular system; Computer software; Coronary Arteriosclerosis; Defect; Detection; Development; Diagnosis; Diagnostic; Diagnostic tests; Disease; Early Diagnosis; Echocardiography; Electrocardiogram; Engineering; Environment; Equipment; Evaluation; Event; Exercise; Exercise stress test; Exertion; Fatigue; Goals; Guidelines; Heart; Heart Diseases; Heart Rate; Image; Imaging Techniques; Investigation; Ionizing radiation; Ischemia; Lead; Lung diseases; Magnetic Resonance; Magnetic Resonance Imaging; Morphologic artifacts; Motion; Myocardial perfusion; Noise; Nuclear; Obesity; Patients; Performance; Perfusion; Phase; Photons; Physiologic pulse; Protocols documentation; Radiation; Research; Resolution; Safety; Sales; Slice; Societies; Staging; Stress; Stress Tests; System; Technology; Testing; Time; Ultrasonography; Validation; attenuation; base; cohort; commercialization; design; design and construction; effective therapy; heart imaging; image processing; imaging modality; improved; innovation; insight; magnetic field; meetings; new technology; older patient; prototype; public health relevance; response; rib bone structure; soft tissue; technology development; tomography; tool; treatment strategy

DESCRIPTION (provided by applicant): Exercise stress testing with imaging is widely used to detect heart disease, but current stress imaging systems suffer from false positives that may lead to unnecessary invasive testing, and false negatives that may miss disease detection until a serious event occurs. Thus, consistently accurate stress imaging remains an important target for technology development. Cardiac magnetic resonance (CMR) provides superior imaging of the heart without ionizing radiation, but technology has not been developed to allow CMR immediately following maximal exercise stress. A revolutionary change to the current landscape of cardiac stress testing could result by adding exercise testing to CMR, thus establishing a "one-stop" imaging modality for accurately assessing heart disease in a single examination. This project focuses on the research and commercialization of an MRI-based system for enhanced exercise stress testing for patients with suspected cardiovascular disease. The key enabling technology is an innovative non-ferromagnetic treadmill that enables convenient placement immediately adjacent to the MRI machine. Standard treadmills would have to be placed far from the MRI magnet outside the MRI room, leading to critical delays between exercise and image acquisition, as well as safety concerns for compromised patients who must, in a fatigued and stressed state, traverse the distance from the treadmill to the MRI table. Our innovative design will overcome these problems and furthermore, enable image acquisition immediately post-exercise. The resulting high resolution images are expected to be superior to nuclear single photon emission tomography (SPECT) and ultrasound, and clearly show stress wall motion, stress perfusion, and viability. The design, implementation, and feasibility testing of this new technology by a coordinated team of engineers and clinicians (Phase I), followed by a multi-center investigation showing improved accuracy over existing stress imaging methods (Phase II) is expected to lead to a sizeable commercial opportunity for the manufacture and sale of MRI stress testing equipment. Phase I of this project will be accomplished by meeting the following specific aims: " Design and construct an MRI-compatible treadmill capable of performing the standard Bruce stress test protocol immediately adjacent to MRI systems up to 3T field strength. " Demonstrate feasibility of treadmill exercise stress MRI of cardiac function and perfusion in patients with suspected coronary artery disease. Successful achievement of the aims of this Phase I project will lead to Phase II multi-center validation of this new stress imaging modality, including direct comparison with nuclear SPECT. The combination of exercise stress testing and CMR could greatly enhance our understanding of CAD, and enable earlier diagnosis and more effective treatment strategies. PUBLIC HEALTH RELEVANCE: Exercise testing and magnetic resonance imaging (MRI) have independently shown tremendous utility in the diagnosis and treatment of heart disease. Exercise stress testing provides important information about the heart's response to physical exertion, and MRI is a non-invasive imaging method that has many advantages over other imaging techniques. This project develops and evaluates the new equipment needed to combine exercise testing with MRI, and is expected to result in an improved test for the diagnosis of heart disease.

描述（由申请人提供）：通过成像进行运动应力测试被广泛用于检测心脏病，但是当前的压力成像系统遭受了假阳性，可能导致不必要的侵入性测试，以及可能错过疾病检测直到发生严重事件的虚假负面因素。因此，一贯准确的压力成像仍然是技术开发的重要目标。心脏磁共振（CMR）在没有电离辐射的情况下为心脏提供了出色的成像，但是尚未开发技术以在最大运动应力后立即允许CMR。通过将运动测试添加到CMR，从而建立了一种“一站式”成像方式，从而在一次检查中准确评估心脏病，从而导致对心脏应力测试当前景观的革命性变化。该项目着重于基于MRI的系统的研究和商业化，以增强可疑心血管疾病患者的运动胁迫测试。关键的促成技术是一种创新的非铁磁跑步机，可在MRI机器附近的方便放置。标准跑步机必须远离MRI室外的MRI磁铁，从而导致运动和图像获取之间的严重延迟，以及对受损的患者的安全关注，这些患者必须在疲劳和压力状态下从跑步机到MRI桌子的距离。我们的创新设计将克服这些问题，并在运动后立即启用图像获取。预计所得的高分辨率图像将优于核单光子发射断层扫描（SPECT）和超声波，并清楚地显示应力壁运动，应力灌注和生存能力。由工程师和临床医生组成的协调团队（I阶段）对这项新技术的设计，实施和可行性测试，随后进行了多中心调查，表明对现有压力成像方法的准确性提高了（II阶段），预计将为MRI压力测试设备的生产和销售带来较大的商业机会。该项目的第一阶段将实现以下特定目的：“设计和构建一个能够执行与MRI系统相邻的标准Bruce压力测试方案，可与MRI系统执行高达3T野外强度的标准跑步机。”跑步机运动的可行性，表现出对患有悬浮型冠状动脉疾病患者心脏功能和灌注的可行性。成功实现该阶段I项目的目标将导致对这种新的应力成像方式的II期多中心验证，包括与核SPECT的直接比较。运动压力测试和CMR的结合可以大大增强我们对CAD的理解，并实现早期诊断和更有效的治疗策略。公共卫生相关性：运动测试和磁共振成像（MRI）在心脏病的诊断和治疗中独立显示出巨大的效用。运动压力测试提供了有关心脏对身体劳累的反应的重要信息，MRI是一种非侵入性成像方法，比其他成像技术具有许多优势。该项目开发并评估了将运动测试与MRI结合使用所需的新设备，并有望改善对心脏病的诊断。

项目成果

Real-time cine and myocardial perfusion with treadmill exercise stress cardiovascular magnetic resonance in patients referred for stress SPECT.

• DOI: 10.1186/1532-429x-12-41
• 发表时间: 2010-07-12
• 期刊: Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance
• 作者: Raman SV;Dickerson JA;Jekic M;Foster EL;Pennell ML;McCarthy B;Simonetti OP
• 通讯作者: Simonetti OP