An Integrated and Automated Tool for Quantification of Biomechanics in Fetal and Neonatal Echocardiography

用于量化胎儿和新生儿超声心动图生物力学的集成自动化工具

• 批准号: 10704636
• 负责人: Ronald Mark Payne
• 金额: $ 18.97万
• 依托单位: PURDUE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-15 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10704636
• 关键词: Adult; Age; Age Years; Algorithmic Analysis; Biomechanics; Biomedical Engineering; Birth; Cardiac; Cessation of life; Child; Childhood; Clinical; Clinical Management; Clinical Sciences; Color; Common Ventricle; Computer software; Congenital Abnormality; Data; Development; Diagnosis; Diagnostic; Diastolic blood pressure; Dimensions; Disease; Disease-Free Survival; EFRAC; Echocardiography; Evolution; Failure; Fetal Heart; Fontan Procedure; Functional disorder; Goals; Growth; Heart; Heart Ventricle; Heart failure; Hypoplastic Left Heart Syndrome; Indiana; Infant; Infrastructure; Intervention; Measurement; Measures; Mechanics; Methods; Morphology; Neonatal; Operative Surgical Procedures; Outcome; Palliative Surgery; Patient-Focused Outcomes; Patients; Pattern; Pediatric Hospitals; Pediatric cardiology; Physiologic intraventricular pressure; Pregnancy; Prognosis; Reproducibility; Scanning; Single ventricle congenital heart disease; Survival Rate; Testing; Time; Transcend; Universities; Ventricular; Work; automated analysis; clinical practice; clinical prognosis; comparison control; congenital heart disorder; design; fetal; heart function; hemodynamics; improved; improved outcome; longitudinal analysis; longitudinal, prospective study; medical schools; novel; outcome prediction; palliation; patient stratification; pediatric heart failure; pediatric patients; postnatal; precision medicine; predictive tools; prenatal; pressure; prognostic; prospective; risk stratification; success; tool

PROJECT SUMMARY The single ventricle (SV) heart is a critical birth defect that requires several palliative surgeries for patient survival. Even when these surgeries are considered successful, SV hearts can develop heart failure (HF), resulting in just a 43% 30-years of age survival rate for patients. The SV's biomechanics underlying the progression to HF could provide critical enabling information that could help improve SV patients' outcomes and surgical planning. Despite that, SV biomechanics remain not well understood. Existing echocardiography analysis tools are designed for adult hearts and cannot accurately or reproducibly evaluate fetal and neonatal echocardiograms. Thus, currently, there are no available tools to study the biomechanics of SV hearts. Beyond this, conventional metrics such as ejection fraction (EF) fail to capture SV hearts' growth and remodeling. We previously developed a novel, automated analysis tools that can quantify ventricular biomechanics from routine B-mode and color Doppler recordings. We tested these tools using pre- and postnatal normal and hypoplastic left heart patients. We simultaneously measured conventional metrics (e.g., EF), global longitudinal strain and strain rate, interventricular pressure difference, and flow energy losses. Such measurements have never been possible using existing echocardiogram analysis tools. Our initial findings indicated these metrics differed between SV and normal postnatal hearts, with statistical significance. We propose to test the hypothesis that differences in diastolic flow, pressure, and energy-loss, correlate with pre- and post-Fontan procedure outcomes and predict progression to failure. We will aim to (i) optimize and establish the accuracy and reliability of our novel and integrated echocardiography analysis for SV hearts and subsequently use our tools to establish quantitative biomechanics and hemodynamic differences between healthy and SV hearts. Further, we aim to: (ii) analyze SV hearts using a prospective longitudinal study to develop correlations between the evolution of hemodynamics and biomechanics parameters of SV hearts with time-point outcomes, such as growth and event-free survival at fetal, neonatal, and pre- and post-Fontan stages. This project aims to improve predictions of outcomes and enable better surgical planning and clinical management for children with SV heart defects. This project's goal would be to establish our tools in clinical practice.

项目概要 单心室 (SV) 心脏是一种严重的出生缺陷，需要对患者进行多次姑息性手术 生存。即使这些手术被认为是成功的，SV 心脏也可能发展为心力衰竭 (HF)， 导致患者 30 岁生存率仅为 43%。 SV 的生物力学基础 进展为 HF 可以提供关键的支持信息，有助于改善 SV 患者的预后和 手术计划。尽管如此，SV 生物力学仍然没有得到很好的理解。现有超声心动图 分析工具是为成人心脏设计的，无法准确或可重复地评估胎儿和新生儿 超声心动图。因此，目前没有可用的工具来研究 SV 心脏的生物力学。 除此之外，射血分数 (EF) 等传统指标无法捕捉 SV 心脏的生长和重塑。 我们之前开发了一种新颖的自动化分析工具，可以量化心室生物力学 常规 B 型和彩色多普勒记录。我们使用产前和产后正常和 左心发育不良患者。我们同时测量了传统指标（例如 EF）、全局纵向指标 应变和应变率、室间压差和流动能量损失。此类测量有 使用现有的超声心动图分析工具是不可能的。我们的初步发现表明了这些指标 SV 与正常出生后心脏之间存在差异，具有统计学意义。 我们建议检验以下假设：舒张流量、压力和能量损失的差异， 与 Fontan 手术前后的结果相关并预测失败的进展。我们将瞄准 (i) 优化并建立我们新颖的集成超声心动图的准确性和可靠性 分析 SV 心脏，然后使用我们的工具建立定量生物力学和 健康心脏和 SV 心脏之间的血流动力学差异。此外，我们的目标是：(ii) 使用 前瞻性纵向研究旨在开发血流动力学演变与 SV 心脏的生物力学参数与时间点结果，例如胎儿的生长和无事件生存， 新生儿、Fontan 前期和后期。 该项目旨在改善结果预测并实现更好的手术计划和临床 患有 SV 心脏缺陷的儿童的管理。该项目的目标是建立我们的临床工具 实践。