Validation of Myocardial Oxygen Extraction Fraction Measurement with MRI

MRI 心肌氧提取分数测量的验证

• 批准号: 10735534
• 负责人: Pamela K Woodard
• 金额: $ 65.25万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-15 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10735534
• 关键词: Acetates; Affect; Animal Model; Area; Artificial Intelligence; Biological; Blood; Blood Volume; Blood flow; Canis familiaris; Cardiac; Cardiomyopathies; Cardiovascular system; Catheters; Cell Respiration; Clinical; Compensation; Consumption; Contrast Media; Coronary Arteriosclerosis; Coronary Stenosis; Coronary sinus structure; Coupled; Coupling; Data Analyses; Defect; Dependence; Detection; Development; Diagnosis; Dilated Cardiomyopathy; Drops; Early Diagnosis; Equation; Equilibrium; Evaluation; Exercise; Functional disorder; Heart; Heart Diseases; Heart Valve Diseases; Heart failure; Human Volunteers; Hyperemia; Hypertrophic Cardiomyopathy; Image; Imaging Techniques; Injury; Intervention; Intravenous; Ionizing radiation; Ischemia; Magnetic Resonance; Magnetic Resonance Imaging; Maps; Measurement; Measures; Mechanics; Metabolic; Metabolic dysfunction; Metabolism; Methods; Monitor; Morphologic artifacts; Muscle Cells; Myocardial; Myocardial Infarction; Myocardial Ischemia; Myocardial perfusion; Myocardial tissue; Myocardium; Noise; Oxygen; Oxygen Consumption; Pathologic; Pathology; Patient Selection; Patients; Perfusion; Phase; Physiological; Positron-Emission Tomography; Pre-Clinical Model; Principal Investigator; Recovery of Function; Reperfusion Therapy; Residual state; Resolution; Rest; Sampling; Seminal; Signal Transduction; Stimulus; Structural defect; System; Techniques; Testing; Time; Tissues; Validation; Vasodilation; Ventricular; Water; Work; canine model; cardiac magnetic resonance imaging; cardioprotection; clinical application; cohort; cost; deep learning; deep learning model; detection method; fluorodeoxyglucose; fluorodeoxyglucose positron emission tomography; glucose uptake; healthy volunteer; imaging modality; improved; in vivo; ischemic cardiomyopathy; magnetic field; novel; novel therapeutic intervention; nuclear imaging; pharmacologic; pre-clinical; preservation; septic; tool; uptake; validation studies

Imbalance of myocardial oxygen supply and consumption precipitates a cascade of physiological changes resulting in ischemic pathology. While assessment of myocardial perfusion alone may allow accurate assessment of myocardial oxygen consumption in some pathophysiological conditions, the perfusion-oxygen consumption relationship is derailed in several conditions, including: myocardial ischemia and infarction, hypertrophic and dilated cardiomyopathies, heart failure, valvular heart disease, and septic cardiomyopathy. Importantly, this oxygen supply/perfusion mismatch occurs early – before mechanical dysfunction. Therefore, evaluation of myocardial consumption independent of perfusion is of importance for early diagnosis and monitoring of these pathophysiological conditions. Myocardial oxygen extraction fraction (mOEF), which relates the biologic coupling of myocardial blood flow (oxygen supply) to oxygen consumption, may provide a more accurate assessment of this balance. For example, in ischemic cardiomyopathy, adequate myocardial perfusion is commonly reduced by high grade epicardial coronary artery stenoses. To avoid ischemia-caused injury, mOEF is likely to be increased to compensate for decrease in myocardial perfusion and oxygen delivery to myocytes. Consequently, the affected myocardial regions drop into a so called “hibernating” state that is effective in the short term. In this respect, an accurate mOEF assessment is a unique tool, with the potential to determine the likelihood of cardiac functional recovery after reperfusion. To date, the reference method for non-invasive quantification of mOEF in vivo is Positron Emission Tomography (PET). We recently developed a novel contrast- free cardiovascular magnetic resonance (CMR) acquisition method to quantify mOEF in vivo that has several advantages over PET: our CMR method has better spatial resolution, shorter acquisition time, does not expose the patient to ionizing radiation, and could be more widely available than PET. The overall objective of this study is to leverage our expertise in CMR imaging to refine and rigorously validate this new mOEF method. In Aim 1. This technique will be developed with assistance of a novel deep learning approach for artifact-free images and then validated using large animal models with and without induced coronary artery disease. Invasive catheter-measured and non-invasive PET-MRI-measured mOEF will be used as reference. In Aim 2, the CMR mOEF method will be validated in a small cohort of patients with hibernating myocardium in vivo, with the availability of 18F-FDG-PET as reference. Although we will study this mOEF technique in hibernating myocardium, this imaging method can be applied to the diagnosis and evaluation of treatments in a wide range of cardiomyopathies. Given the capability of CMR for the comprehensive assessment of myocardial function, tissue characterization, and viability, successful completion of CMR mOEF validation will provide a ‘one-stop shop’ evaluation of metabolic, functional, and structural abnormalities in patients with cardiomyopathy. Furthermore, the advantage of fast imaging without using an intravenous contrast agent is well-suited for repeat quantitative mOEF measurements needed to guide the effects of novel therapeutic interventional strategies.

心肌供氧消耗失衡，引发一系列生理变化 导致缺血性病理学，而单独评估心肌灌注可能可以提供准确的结果。 在某些病理生理条件下评估心肌耗氧量，灌注氧 消费关系在多种情况下脱轨，包括：心肌缺血和梗塞， 肥厚型和扩张型心肌病、心力衰竭、瓣膜性心脏病和脓毒性心肌病。 重要的是，这种供氧/灌注不匹配很早就发生——在机械功能障碍之前。 独立于灌注的心肌消耗评估对于早期诊断和治疗非常重要 监测这些病理生理状况。 心肌血流（供氧）与耗氧量的生物耦合可能提供更多 准确评估这种平衡，例如，在缺血性心肌病中，充足的心肌灌注。 高度心外膜冠状动脉狭窄通常会减少 mOEF，以避免缺血引起的损伤。 可能会增加以补偿心肌灌注和心肌细胞氧输送的减少。 在测试区域中，受影响的心肌会进入所谓的“冬眠”状态，该状态在 在这方面，准确的 mOEF 评估是一个独特的工具，有可能确定 再灌注后心脏功能恢复的可能性迄今为止，无创性的参考方法。 体内 mOEF 的定量方法是正电子发射断层扫描 (PET)，我们最近开发了一种新型对比-。 免费的心血管磁共振 (CMR) 采集方法可量化体内 mOEF，具有多种功能 与 PET 相比的优势：我们的 CMR 方法具有更好的空间分辨率、更短的采集时间、不暴露 患者免受电离辐射的影响，并且比 PET 的应用范围更广。 总体目标 这项研究的目的是利用我们在 CMR 成像方面的专业知识来完善和严格验证这种新的 mOEF 方法。 目标 1. 该技术将在一种新颖的深度学习方法的帮助下开发，以实现无伪影 图像，然后使用有或没有诱发冠状动脉疾病的大型动物模型进行验证。 在目标 2 中，导管测量和非侵入性 PET-MRI 测量的 mOEF 将用作参考。 mOEF 方法将在一小群体内冬眠心肌的患者中进行验证， 尽管我们将在冬眠心肌中研究这种 mOEF 技术，但 18F-FDG-PET 的可用性仍可作为参考。 这种成像方法可广泛应用于诊断和治疗评估 鉴于 CMR 能够全面评估心肌功能、组织。 表征和可行性，成功完成 CMR mOEF 验证将提供“一站式服务” 评估心肌病患者的代谢、功能和结构异常。 无需使用静脉造影剂即可快速成像的优点非常适合重复定量 mOEF 测量需要指导新型治疗干预策略的效果。