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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Scott, Jane
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University of Virginia
Internal Medicine/Medicine
Schools of Medicine
United States
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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 (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
Malhotra, Rohit; Bilchick, Kenneth C; DiMarco, John P (2014) Usefulness of pharmacologic conversion of atrial fibrillation during dofetilide loading without the need for electrical cardioversion to predict durable response to therapy. Am J Cardiol 113:475-9
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
Porterfield, Christopher; Ferguson, John D; Bilchick, Kenneth C (2014) An unexpected intracardiac echocardiography finding on the cavotricuspid isthmus. J Cardiovasc Electrophysiol 25:444
Bilchick, Kenneth C; Kuruvilla, Sujith; Hamirani, Yasmin S et al. (2014) Impact of mechanical activation, scar, and electrical timing on cardiac resynchronization therapy response and clinical outcomes. J Am Coll Cardiol 63:1657-66
Moorman, Liza P; Moorman, J Randall; DiMarco, John P et al. (2013) Increasing lead burden correlates with externalized cables during systematic fluoroscopic screening of Riata leads. J Interv Card Electrophysiol 37:63-8
Bilchick, Kenneth C (2012) Integration of CMR scar imaging and electroanatomic mapping: the future of VT ablation? JACC Cardiovasc Imaging 5:211-3
Bilchick, Kenneth C; Kamath, Sandeep; DiMarco, John P et al. (2010) Bundle-branch block morphology and other predictors of outcome after cardiac resynchronization therapy in Medicare patients. Circulation 122:2022-30