Measuring Left Ventricular Dyssynchrony from ECG-gated Myocardial Perfusion SPECT

通过心电门控心肌灌注 SPECT 测量左心室不同步

• 批准号: 8070470
• 负责人: Ji Chen
• 金额: $ 38.75万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-07-15 至 2013-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8070470
• 关键词: Accounting; Acute; Admission activity; Affect; Cardiac; Cardiomyopathies; Clinical; Clinical Trials; Coupled; Data; Databases; Development; Diagnosis; Direct Costs; Echocardiography; Electrocardiogram; Evaluation; FDA approved; Facilities and Administrative Costs; Foundations; Goals; Health; Heart failure; Hospitals; Image; Left; Left ventricular structure; Measurement; Measures; Mechanics; Myocardial perfusion; Patient Selection; Patients; Perfusion; Phase; Procedures; Refractory; Relaxation; Research; Simulate; Software Tools; Techniques; United States; Ventricular; base; conventional therapy; digital; improved; indexing; novel; outcome forecast; response; simulation; single photon emission computed tomography; software development; tool

DESCRIPTION (provided by applicant): Heart failure (HF) affects more than 5 million people in the United States, and the number increases by more than 0.5 million every year. Acute decompensated HF accounts for over one million hospital admissions per year. The estimated direct and indirect cost for HF in 2006 is $29.6 billion. Our long-term objective is to improve the prognosis of HF patients by more accurately predicting their response to cardiac resynchronization therapy (CRT) and/or revascularization. CRT has been approved by FDA as a treatment of HF patient's refractory to conventional therapy. However, 20-40% of the patients who selected for CRT based on the conventional criteria do not respond to CRT. Echocardiography has shown to improve patient selection for CRT, but it requires expertise to obtain reliable results. The PROSPECT trial has shown that under "real-world" conditions the current available echocardiographic techniques are not ready for routine prediction of CRT response. Our primary goal is to predict the response to CRT in patients with HF-induced conduction disturbances and ventricular dyssynchrony. It will be accomplished by improved diagnosis and characterization of left ventricular (LV) dyssynchrony using our novel, quantitative multi-harmonic phase analysis (MHPA) of ECG-gated single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) study and by integrating this evaluation of LV dyssynchrony to our established quantification of myocardial perfusion and viability from the same study. This integrated quantification will also be used to predict the response to revascularization in HF patients with ischemic cardiomyopathy - our secondary goal. We propose to measure LV dyssynchrony from ECG-gated SPECT MPI, because 1) it is widely available, 2) it is highly reproducible, and 3) it can provide additional perfusion/viability information, which is needed for the management of the HF patient, without any additional procedure. Specifically, in this research we will 1) develop LV dyssynchrony simulation tools that can simulate gated SPECT MPI studies with a variety of LV dyssynchrony patters, 2) develop MHPA and optimize it by using the simulation tools to determine the imaging requirements for accurate MHPA measurements, 3) define and validate quantitative indices that describe LV dyssynchrony and development normal databases for these indices, 4) use the LV dyssynchrony quantification coupled with our established perfusion/viability quantification to predict the response to CRT in HF patients, and 5) use the integrated quantification of LV dyssynchrony, perfusion, and viability to predict the response to revascularization in HF patients with ischemic cardiomyopathy. Upon completion of this research, we will establish a strong scientific foundation for our phase analysis approach thus supporting a large clinical trial to prove the usefulness of ECG-gated SPECT MPI with our integrated quantification of LV dyssynchrony, perfusion, and viability in prognosis for HF patients and promoting widespread utilization clinically. PUBLIC HEALTH RELEVANCE: Heart failure affects more than 5 million people in the United States, and the number increases by more than 0.5 million every year. Acute decompensated heart failure accounts for over one million hospital admissions per year, and the estimated direct and indirect cost for heart failure in 2006 is $29.6 billion. This research is to establish a strong scientific foundation for our integrated quantification of left ventricular dyssynchrony, perfusion, and viability from the conventional ECG-gated SPECT myocardial perfusion imaging studies to improve the prognosis of heart failure patients by more accurately predicting their response to cardiac resynchronization therapy and/or revascularization.

描述（由申请人提供）：心力衰竭（HF）在美国影响超过500万人，每年的数量增加了50万。急性代偿HF每年占住院时间超过一百万。 HF在2006年的估计直接和间接成本为296亿美元。我们的长期目标是通过更准确地预测他们对心脏重新同步治疗（CRT）和/或血运重建的反应来改善HF患者的预后。 FDA已批准CRT，以治疗HF患者对常规疗法的难治性。但是，根据常规标准选择CRT的患者中有20-40％对CRT没有反应。超声心动图已显示可以改善CRT的患者选择，但需要专业知识才能获得可靠的结果。前景试验表明，在“现实世界”条件下，当前可用的超声心动图技术尚未准备好进行CRT响应的常规预测。我们的主要目的是预测HF引起的传导障碍和心室不体障碍患者对CRT的反应。这将通过改进左心室（LV）异常的诊断和表征，使用我们的新颖，定量的ECG门控单光子发射层析成像（Spect）心脏灌注（MPI）研究（MPI）研究并通过将LV Dysssynchrony的评估整合到我们的评估中，我们的量化性繁殖率（MHPA）的定量多谐波相分析（MHPA）通过我们的LV Dyssynchrony的评估来实现。同一研究。该综合定量还将用于预测缺血性心肌病（我们的次要目标）HF患者对血运重建的反应。我们建议从ECG门控SPECT MPI中测量LV lv dysnchrony，因为1）它是广泛可用的，2）它是高度可重现的，3）它可以提供其他灌注/生存能力信息，这是HF患者的管理所需的，而无需任何其他程序。具体而言，在这项研究中，我们将1）开发LV Dyssnchrony模拟工具，可以使用各种LV lv dyssynchrony模式模拟封闭的幽灵MPI研究，2）开发MHPA并通过使用模拟工具来确定成像要求，以确定成像需求，以确定成像要求，以确定MHPA测量的准确量子和验证量子，3）定义量子量，3） 4）使用LV失与同步的定量，再加上我们已建立的灌注/生存力定量，以预测HF患者对CRT的反应，5）使用LV功能障碍，灌注和生存能力的综合定量，以预测HF HF患有缺陷性心肌疗法的心脏反应的反应。这项研究完成后，我们将为我们的相分析方法建立强大的科学基础，从而支持一项大型临床试验，以证明ECG门控SPECT MPI通过我们对LV Dysnchrony的综合量化，灌注和生存能力的综合定量对HF患者的预后和生存能力，并在HF患者中的生存能力并促进广泛利用。公共卫生相关性：心力衰竭在美国影响超过500万人，每年的数量增加了50万。急性代偿性心力衰竭每年的住院时间超过一百万，2006年心力衰竭的估计直接和间接成本为296亿美元。这项研究是为我们综合量化左心室异位障碍，灌注和生存能力的综合定量基础，该基础是传统的ECG门控幽灵心肌灌注成像研究，以更准确地预测他们对心脏重新同步治疗和/或血管生成的反应，从而改善心力衰竭患者的预后。