High spatial resolution evaluation of subclinical regions of myocardial dysfunction in adult patients with tetralogy of Fallot

法洛四联症成人患者心肌功能障碍亚临床区域的高空间分辨率评估

• 批准号: 10750829
• 负责人: Amanda Craine
• 金额: $ 4.07万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10750829
• 关键词: Adult; Age Years; Agreement; Anatomy; Area; Arrhythmia; Cardiac; Cardiopulmonary; Caring; Categories; Clinical; Clinical Management; Complex; Complication; Cross-Sectional Studies; Data; Detection; Deterioration; Dose; Early Diagnosis; Electrocardiogram; Elements; Endocardium; Evaluation; Event; Exercise Test; Exercise Tolerance; Functional disorder; Geometry; Global Change; Goals; Heart failure; Heterogeneity; Image; Impairment; Life; Longitudinal Studies; Maps; Measurement; Measures; Methods; Modeling; Myocardial; Myocardial dysfunction; Myocardial perfusion; Operative Surgical Procedures; Outcome; Patients; Performance; Physiologic intraventricular pressure; Population; Quality of life; Residual state; Resolution; Right Ventricular Dysfunction; Right Ventricular Function; Risk; Stress; Survivors; Techniques; Tetralogy of Fallot; Therapeutic; Variant; Ventricular; Ventricular Dysfunction; Visualization; Work; X-Ray Computed Tomography; clinical care; clinical decision-making; congenital heart disorder; experience; follow-up; implantable device; improved; predict clinical outcome; preservation; pressure; regional difference; repaired; sudden cardiac death; symptomatology; tool

Project Summary Surgical repair of tetralogy of Fallot (rTOF) has led to excellent long-term survival, yet rTOF survivors often experience residual and progressive right ventricular (RV) dysfunction that burden these patients with adverse cardiac events later in life. Given this growing population, there is a strong clinical need for techniques to guide patient management. CT can be used to robustly obtain global measures of function in adult rTOF patients, but regional dysfunction is not currently quantified. Strain evaluation can be limited by changes in ventricular geometry and dyssynchronous contraction, both of which are common in rTOF patients. Myocardial work (MW) – clinically measured as the ventricular pressure-strain loop area – can overcome this concern, as it is closely related to myocardial perfusion and has been shown to be more independent of loading conditions. However, ventricular pressure measurements do not capture regional heterogeneities in myocardial stress and the impact of this approximation has not been explored. Further, the clinical utility of MW to detect early RV dysfunction in rTOF patients with CT has not been established. We have recently developed MWCT, an estimate of regional MW that combines regional endocardial strain measurements from ECG-gated CT (RSCT) and RV pressure waveforms. The proposed project aims to investigate MWCT as a quantitative tool to capture regions of subclinical dysfunction in adult rTOF patients. The ability for MWCT to detect regional dysfunction will be compared to advanced MW estimates derived from finite- element models of regional endocardial stress and RSCT. This aim will establish the simple, pressure based MWCT estimate as an effective tool for characterizing regional RV performance. Further, this aim will compare FE methods and establish an approach to measure MW as the endocardial stress-strain loop area within our MWCT pipeline. Cross-sectional CT imaging will assess whether well-performing areas on MWCT agree with cardiopulmonary exercise test (CPET) findings better than strain alone. Additionally, longitudinal evaluation via functional class and CT imaging will be performed to assess whether the amount of discordant endocardium (disagreement between regional work and strain measurements) corresponds with worsening symptomatology and dysfunction respectively. This aim will demonstrate that capturing early dysfunction will improve clinical care by detecting adverse remodeling prior to global changes. The long-term goal of this proposal is to establish CT as a feasible method for evaluating regional RV function and develop robust quantitative tools for early detection of dysfunction in all rTOF survivors.

项目概要 法洛四联症 (rTOF) 的手术修复取得了良好的长期生存率，但 rTOF 幸存者往往 经历残余和进行性右心室（RV）功能障碍，给这些患者带来不良负担 鉴于人口不断增长，临床迫切需要指导技术。 CT 可用于可靠地获得成人 rTOF 患者的整体功能测量，但 目前无法量化区域功能障碍，应变评估可能受到心室变化的限制。 几何形状和不同步收缩，这两者在 rTOF 患者中都很常见。 – 临床上测量心室压力应变环面积 – 可以克服这个问题，因为它与 与心肌灌注有关，并且已被证明更独立于负荷条件。 心室压力测量不能捕捉心肌应激的区域异质性和 此外，尚未探讨 MW 检测早期 RV 的临床效用。 rTOF 患者的 CT 功能障碍尚未确定。 我们最近开发了 MWCT，这是结合区域心内膜应变的区域 MW 估计 拟议项目旨在通过心电门控 CT (RSCT) 和 RV 压力波形进行测量。 研究 MWCT 作为捕获成人 rTOF 患者亚临床功能障碍区域的定量工具。 MWCT 检测区域功能障碍的能力将与源自有限的先进 MW 估计进行比较 区域心内膜应力和 RSCT 的元素模型 这一目标将建立简单的、基于压力的模型。 MWCT 估计作为表征区域 RV 性能的有效工具，此外，该目标还将进行比较。 FE 方法并建立了一种测量 MW 作为我们的心内膜应力应变环面积的方法 MWCT 管道横截面 CT 成像将评估 MWCT 上表现良好的区域是否与 心肺运动测试（CPET）的结果优于单独的应变此外，通过纵向评估。 将进行功能分级和 CT 成像来评估心内膜的数量是否不一致 （区域工作和应变测量之间的不一致）与恶化的症状相对应 该目标将证明捕获早期功能障碍将改善临床。 通过在全球变化之前检测不良重塑来进行护理 该提案的长期目标是 建立 CT 作为评估区域 RV 功能的可行方法，并开发稳健的定量工具 及早发现所有 rTOF 幸存者的功能障碍。