Improving Phenotypic Classification and Prediction of Treatment Outcomes in Patients with Non-ischemic Cardiomyopathy and Functional Mitral Regurgitation

改善非缺血性心肌病和功能性二尖瓣反流患者的表型分类和治疗结果预测

• 批准号: 10717066
• 负责人: DEBORAH KWON
• 金额: $ 77.74万
• 依托单位: CLEVELAND CLINIC LERNER COM-CWRU
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-10 至 2028-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10717066
• 关键词: Address; Anatomy; Biological; Cardiac; Cardiomyopathies; Cardiovascular system; Characteristics; Classification; Clinical; Clinical Trials; Complex; Consensus; Databases; Devices; Dimensions; Disease-Free Survival; Echocardiography; Evolution; Goals; Guidelines; Heart failure; Heterogeneity; Infarction; Intervention; Ischemia; Left; Left Ventricular Remodeling; Longitudinal Studies; Machine Learning; Magnetic Resonance; Medical; Methods; Mitral Valve; Mitral Valve Insufficiency; Modernization; Outcome; Outcome Assessment; Patient Selection; Patients; Pattern; Phenotype; Positioning Attribute; Prediction of Response to Therapy; Prevalence; Process; Prognosis; Reproducibility; Research; Risk; Selection Criteria; Severities; Testing; Texture; Therapeutic; Tissues; Treatment Failure; Treatment outcome; United States; Ventricular; analytical method; biological heterogeneity; cardiac magnetic resonance imaging; clinical heterogeneity; clinically relevant; disease classification; imaging modality; improved; improved outcome; longitudinal, prospective study; magnetic resonance imaging biomarker; mortality; mortality risk; novel; outcome prediction; patient population; personalized risk prediction; radiomics; repaired; response; risk stratification; targeted treatment

Project Summary Functional mitral regurgitation (FMR) portends a bleak prognosis and is a common consequence of ischemic and non-ischemic cardiomyopathy (ICM, NICM), where adverse annular and left ventricular (LV) remodeling and/or infarction alters mitral valve (MV) function. Prior studies demonstrate significant increases in mortality risk as severity of FMR increases; mortality rates range from 15-40% at 1 year. Furthermore, as the prevalence of heart failure (HF) is rising, FMR is projected to double from over 2 million patients in 2000 to over 4 million patients in the United States by 2030. Defining FMR severity, optimal timing of intervention, and most appropriate method for intervention remain controversial. Recently, MITRA-FR and COAPT trials demonstrated contrasting survival benefit with percutaneous MV repair, demonstrating the importance and need for more optimal selection criteria. Currently, the patient selection criteria for Mitraclip therapy are solely based on MV anatomy and controversial echocardiographic criteria for FMR severity. Cardiac magnetic resonance (CMR) provides an exciting opportunity to address numerous unmet needs regarding characterizing FMR and the need for more optimal selection criteria for improving outcomes. Superior accuracy and reproducibility for quantification of LV size and function, and gold standard tissue characterization, positions CMR as the ideal imaging modality for comprehensively characterizing FMR and the underlying myopathic processes that significantly impact response to FMR therapies. The goal of the current research is to develop personalized risk prediction for FMR patients through explainable unsupervised phenomapping enriched with advanced CMR imaging biomarkers, and to determine the CMR predictors of reverse remodeling following modern therapies for FMR.

项目摘要 功能性二尖瓣反流（FMR）预示着凄凉的预后，是一个常见 缺血性和非缺血性心肌病（ICM，NICM）的后果，其中不良 环形和左心室（LV）重塑和/或梗塞改变二尖瓣（MV）功能。 先前的研究表明，随着FMR的严重程度的增加，死亡率风险显着增加。 死亡率范围为1年的15-40％。此外，随着心力衰竭的流行 （HF）正在上升，FMR预计将从2000年的2000多名患者增加到400万人 到2030年，美国的患者。定义FMR严重程度，干预的最佳时机和 最合适的干预方法仍然存在争议。最近，mitra-fr和 Coapt试验显示出与经皮MV修复的对比鲜明的生存益处， 表明对更最佳选择标准的重要性和需求。目前，病人 Mitraclip疗法的选择标准仅基于MV解剖结构和有争议的 FMR严重性的超声心动图标准。心脏磁共振（CMR）提供了 令人兴奋的机会来满足众多未满足的需求，以表征FMR和需求 有关改善结果的最佳选择标准。卓越的准确性和可重复性 LV大小和功能的量化以及金标准组织表征，将CMR定位为 理想的成像方式，用于全面表征FMR和潜在的肌病 显着影响对FMR疗法反应的过程。当前研究的目的是 通过可解释的无监督者为FMR患者开发个性化风险预测 具有高级CMR成像生物标志物的现象，并确定CMR FMR现代疗法后反向重塑的预测指标。