Development of an automatic real-time personalized non-invasive localization of the site of origin of the earliest ventricular activation

开发最早心室激动起源部位的自动实时个性化无创定位

基本信息

批准号：
10579726
负责人：
Shijie Zhou
金额：
$ 40.55万
依托单位：
MIAMI UNIVERSITY OXFORD
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-09-01 至 2026-08-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10579726
关键词：
3-Dimensional Ablation Academic Research Enhancement Awards Accounting Arrhythmia Biomedical Engineering Cardiac Cardiac Electrophysiologic Techniques Cardiac ablation Case Series Catheters Cause of Death Cessation of life Clinical Clinical Data Computer software Data Data Set Developed Countries Development Diagnosis Electrocardiogram Encapsulated Event Geometry Goals Heart Arrest Heart Diseases Image Implantable Defibrillators Lead Learning Left ventricular structure MRI Scans Magnetic Resonance Imaging Maps Methodology Methods Mission Modality Modeling Morphology Myocardium National Heart, Lung, and Blood Institute Nature Patient Care Patients Population Procedures Prospective, cohort study Public Health Radiation therapy Recurrence Research Right ventricular structure Role Site Statistical Models Structure Surface System Techniques Technology Time Tissues United States United States National Institutes of Health Ventricular Ventricular Arrhythmia Ventricular Premature Complexes Ventricular Tachycardia Work X-Ray Computed Tomography clinical database computerized high risk image processing improved innovation mortality novel prospective signal processing software development success time use usability

项目摘要

Project Summary Sudden cardiac arrest is one of the leading causes of death in developed countries, accounting for approximately 350,000 deaths per year in the United States. The majority of those events are caused by ventricular arrhythmias (VA). Implantable defibrillators reduce mortality in high-risk patients, but do not prevent recurrent arrhythmias. Suppression of recurrent ventricular tachycardia (VT) can be accomplished effectively with catheter ablation; more recently stereotactic body radiotherapy (SBRT) has been shown to have a potential role. Accurate identification of the substrate responsible for the VA is key to the success of either of these modalities and may be facilitated using the standard 12-lead ECG to noninvasively identify the site from which a focal ventricular tachycardia (VT)/premature ventricular complex (PVC) arises or from which a reentrant circuit exits the central isthmus to activate the “normal” myocardium. Currently, there is not an automatic real-time non-invasive patient-specific approach that can be used to accurately identify the site of origin (SoO) of VA using the 12-lead ECG. Rapid 12-lead ECG interpretation to identify the SoO of VA requires expertise and could be facilitated with a computerized method to automatically locate the VT exit/PVC origin site in real-time. The ability to accurately identify the VT exit/PVC origin site enables the electrophysiologist to concentrate mapping/targeting to a specific region. To tackle this problem, this research proposes to develop a novel non-invasive 3D mapping technique that relies on the assembly of personalized ventricular surfaces from CT/MRI scans in combination with a statistical estimate derived from a large clinical database to accurately identify the VT exit/PVC origin site from an induced/recorded VT/PVC ECG in real time. The project is interdisciplinary as it combines expertise in biomedical engineering, clinical cardiac electrophysiology, ECG signal processing, image processing, and computational statistical modeling. To this end, the project will include the following two activities: 1) to develop the proposed system in clinically usable software; 2) to assess the accuracy of the proposed software in a prospective case-series study (with the goal of achieving a mean localization error of less than 10 mm). The proposed software delivered by this project will provide significant accuracy improvement in the VT exit/PVC origin site localization, potentially decrease in the time of an invasive VA ablation procedure, and would be helpful to accurately target VT for non-invasive cardiac SBRT. The proposed project is innovative in proposing to bring computational statistical modeling that integrates structure data (CT/MRI imaging), function data (ECG), and a large clinical dataset into the realm of contemporary patient care. At its core, the project is of translational nature, with personalized computational statistical modeling being used for guidance of clinical therapies.

项目概要心脏骤停是发达国家导致死亡的主要原因之一美国每年约有 35 万人死亡，其中大部分是由以下原因造成的。室性心律失常 (VA) 可以降低高危患者的死亡率，但不能降低死亡率。可以预防复发性心律失常，抑制复发性室性心动过速（VT）。最近的立体定向全身放射治疗 (SBRT) 已被证明可以有效地准确识别负责 VA 的底物是成功的关键。这些方式中的任何一种都可以使用标准 12 导联心电图来促进无创识别局灶性室性心动过速 (VT)/室性早搏 (PVC) 发生的部位或目前，有一个折返回路离开中央峡部以激活“正常”心肌。不是一种可用于准确识别患者的自动实时非侵入性方法使用 12 导联心电图确定 VA 的起源位点 (SoO)。快速 12 导联心电图解读以确定 VA 的 SoO 需要专业知识并且可以促进具有计算机化方法实时自动定位VT出口/PVC原点的能力。准确识别 VT 出口/PVC 起源位点使电生理学家能够集中注意力为了解决这个问题，本研究建议开发一种新颖的方法。非侵入性 3D 测绘技术，依赖于个性化心室表面的组装 CT/MRI 扫描结合来自大型临床数据库的统计估计，可以准确地从诱导/记录的 VT/PVC 心电图中实时识别 VT 出口/PVC 起源点该项目是。跨学科，因为它结合了生物医学工程、临床心脏电生理学、心电图方面的专业知识为此，该项目将进行信号处理、图像处理和计算统计建模。包括以下两项活动：1）开发临床可用软件中的拟议系统；在前瞻性案例系列研究中评估拟议软件的准确性（目标是实现平均定位误差小于 10 毫米）。该项目交付的拟议软件将显着提高 VT 的准确性出口/PVC 起源位点定位，可能减少侵入性 VA 消融手术的时间，以及将有助于准确定位 VT 以进行非侵入性心脏 SBRT。该项目具有创新性。提议引入集成结构数据的计算统计模型（CT/MRI 成像），功能数据（心电图）和大型临床数据集进入当代患者护理领域。项目具有转化性质，采用个性化计算统计模型指导临床治疗。