The purpose of this proposal is to foster the scientific development and clinical research skills of Kenneth Bilchick, MD, in order that he may become an independent clinical investigator. The University of Virginia (UVA) will provide him with all the resources of this major academic medical center for this proposal, including a dedicated MR research scanner, state-of-the-art echocardiographic imaging equipment, and a fully equipped Stress lab. This proposal will serve as the foundation for the development of an independent academic career under the guidance of mentor Christopher Kramer, M.D., and co-mentor Frederick Epstein, Ph.D. Of note. Dr. Bilchick's career development plan includes completion of a Masters degree in Clinical Investigation. Heart failure (HF) is a major cause of morbidity and mortality affecting nearly 5 million Americans. Dr. Bilchick's long-term research goal is to develop and apply advanced cardiac imaging techniques to patients with heart failure and cardiac arrhythmias. Cardiac resynchronization therapy (CRT) has great potential clinical benefit for patients with HF, but is limited by difficulties identifying appropriate patients and achieving optimal left ventricular (LV) lead placement. This project employs cine DENSE (displacement encoding with stimulated echoes), a novel cardiac magnetic resonance (CMR) imaging protocol that was developed at UVA and yields very high quality strain data even in dilated and thinned left ventricles. The primary hypothesis of the proposal is that CMR with DENSE assessment of circumferential mechanical dyssynchrony and scar imaging is significantly more accurate than echocardiography in predicting CRT response, with nonresponse the likely result when the LV lead is positioned in or near significant scar. Therefore, this prospective study evaluates whether CMR DENSE assessment of the substrate for resynchronization provides more accurate determination of CRT response than echocardiography (specific aim #1) and whether LV lead sites with significant surrounding scar are associated with lack of CRT response (specific aim #2). Study participants will have clinical assessment, cardiac imaging, cardiopulmonary exercise testing, and neurohormonal assessment at baseline and 6 months after the clinical CRT procedure, as well as long-term follow-up for 3 years after CRT.

Public Health Relevance

Heart failure (HF) is a major cause of morbidity and mortality with nearly 5 million Americans affected. CRT has great potential benefit for the most symptomatic HF patients, but its efficacy has been limited by difficulty identifying appropriate candidates. This study of cine DENSE CMR in patients with HF undergoing CRT is of high public health importance as it seeks to improve CRT candidate selection and optimize the procedure.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Mentored Patient-Oriented Research Career Development Award (K23)
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Special Emphasis Panel (ZHL1-CSR-R (M1))
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Roltsch, Mark
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University of Virginia
Internal Medicine/Medicine
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United States
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Bilchick, Kenneth C; Mealor, Augustus; Gonzalez, Jorge et al. (2016) Effectiveness of integrating delayed computed tomography angiography imaging for left atrial appendage thrombus exclusion into the care of patients undergoing ablation of atrial fibrillation. Heart Rhythm 13:12-9
Mehta, Bhairav B; Auger, Daniel A; Gonzalez, Jorge A et al. (2015) Detection of elevated right ventricular extracellular volume in pulmonary hypertension using Accelerated and Navigator-Gated Look-Locker Imaging for Cardiac T1 Estimation (ANGIE) cardiovascular magnetic resonance. J Cardiovasc Magn Reson 17:110
Hussain, Sarah; Moorman, Liza; Moorman, J Randall et al. (2015) Cost of a recall of a single-center experience managing the Riata defibrillator lead. Am J Cardiol 115:206-8
Hussain, Sarah K; Eddy, Meghan M; Moorman, Liza et al. (2015) Major complications and mortality within 30 days of an electrophysiological procedure at an academic medical center: implications for developing national standards. J Cardiovasc Electrophysiol 26:527-31
Ramachandran, Raghav; Chen, Xiao; Kramer, Christopher M et al. (2015) Singular Value Decomposition Applied to Cardiac Strain from MR Imaging for Selection of Optimal Cardiac Resynchronization Therapy Candidates. Radiology 275:413-20
Mehta, Bhairav B; Chen, Xiao; Bilchick, Kenneth C et al. (2015) Accelerated and navigator-gated look-locker imaging for cardiac t1 estimation (ANGIE): Development and application to T1 mapping of the right ventricle. Magn Reson Med 73:150-60
Bilchick, Kenneth C; Stukenborg, George J (2014) Comparative effectiveness of cardiac resynchronization therapy in combination with implantable defibrillator in patients with heart failure and wide QRS duration. Am J Cardiol 114:1537-42
Porterfield, Christopher; Ferguson, John D; Bilchick, Kenneth C (2014) An unexpected intracardiac echocardiography finding on the cavotricuspid isthmus. J Cardiovasc Electrophysiol 25:444
Parker, Katherine M; Bunting, Ethan; Malhotra, Rohit et al. (2014) Postprocedure mapping of cardiac resynchronization lead position using standard fluoroscopy systems: implications for the nonresponder with scar. Pacing Clin Electrophysiol 37:757-67
Bilchick, Kenneth C (2014) Does cardiac resynchronization therapy benefit patients with right bundle branch block: left ventricular free wall pacing: seldom right for right bundle branch block. Circ Arrhythm Electrophysiol 7:543-52

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