The goal of this career development award project is to develop the research skills of Michael Salerno MD, PhD to become an independent investigator involved in patient-oriented research in the field of cardiovascular imaging. The necessary mentorship in clinical investigation will be provided by his clinical mentor, Dr. Christopher Kramer MD and engineering mentorship will be provided by his co-mentor Dr. Craig Meyer. His career will be further enriched by an advisory committee which includes experts in the development of rapid pulse sequences for myocardial perfusion imaging, quantification of perfusion, and the statistical design and analysis of clinical trials. The University of Virginia wll provide the ideal combination of resources necessary for Dr. Salerno to become an independent investigator. This career development proposal includes didactic training necessary to design, perform and analyze multi-center imaging trials which will be instrumental to his long term success in the field of cardiovascular imaging. This training will lead to a Masters degree in Statistics with a concentration in biostatistics and clinical trials. Dr. Salerno's ultimate plan t to utilize his unique interdisciplinary combination of engineering and clinical expertise in cardiovascular imaging to translate new CMR techniques into clinical practice. His likelihood for success in this endeavor will be significantly increased by further development of his clinical research skills by both his didactic training and mentorship interactions resulting from this caree development award. Adenosine stress perfusion CMR is becoming a promising modality for the evaluation of coronary artery disease with multiple advantages as compared to other imaging techniques including a lack of ionizing radiation, high-spatial resolution, and the ability to accurately quantify myocardial perfusion and ischemic burden. Current CMR first pass perfusion techniques are limited by "dark-rim" artifacts which may be mistaken for true perfusion abnormalities resulting in false positive studies with visual analysis, and may impede accurate quantification of myocardial perfusion for quantitative methods. Furthermore, these techniques are still limited in their temporal resolution, spatial resolution and ventricular coverage. We hypothesize that spiral pulse sequences will be robust to these artifacts, while having the efficiency to provide full ventricular perfusion quantification with high temporal and spatial resolution. Additionally, we hypothesize that these techniques will result in a robust clinical protocol for adenosine stress CMR which will have high specificity.
The specific aims of this project are: (1) To develop spiral based-perfusion pulse sequences to perform absolute quantification of myocardial perfusion with whole heart coverage. (2) To evaluate adenosine stress CMR using spiral trajectories for both qualitative and quantitative assessment of myocardial perfusion in patients with an intermediate probability of CAD to determine the sensitivity and specificity using FFR as a functional gold standard. As nearly 40% of the greater than 1 million heart catheterizations which are performed annually in the US do not demonstrate obstructive CAD, improving the accuracy of non-invasive stress testing techniques could significantly reduce health care costs resulting from patients undergoing expensive and often unnecessary invasive procedures. Improved techniques would also reduce repeated testing for equivocal studies and reduce the number of incorrect diagnoses. Thus, this project has the potential to reduce health care expenditures while improving patient care.

Public Health Relevance

This proposal seeks to create highly innovative quantitative spiral cardiac magnetic resonance pulse sequences to improve adenosine stress CMR. As nearly 40% of the greater than 1 million heart catheterizations which are performed annually in the US do not demonstrate obstructive CAD, improving the accuracy of non-invasive stress testing techniques could significantly reduce health care costs resulting from patients undergoing expensive and often unnecessary invasive procedures. Improved techniques would also reduce repeated testing for equivocal studies and reduce the number of incorrect diagnoses. Thus, this project has the potential to reduce health care expenditures while improving patient care.

Agency
National Institute of Health (NIH)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23HL112910-03
Application #
8700494
Study Section
Special Emphasis Panel (ZHL1)
Program Officer
Scott, Jane
Project Start
Project End
Budget Start
Budget End
Support Year
3
Fiscal Year
2014
Total Cost
Indirect Cost
Name
University of Virginia
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
City
Charlottesville
State
VA
Country
United States
Zip Code
22904
Feng, Xue; Salerno, Michael; Kramer, Christopher M et al. (2016) Non-Cartesian balanced steady-state free precession pulse sequences for real-time cardiac MRI. Magn Reson Med 75:1546-55
Salerno, Michael; Kramer, Christopher M (2016) Myocardial Extracellular Volume: Unifying Form and Function in Heart Failure With Preserved Ejection Fraction. J Am Coll Cardiol 67:1826-8
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
Yang, Yang; Kramer, Christopher M; Shaw, Peter W et al. (2016) First-pass myocardial perfusion imaging with whole-heart coverage using L1-SPIRiT accelerated variable density spiral trajectories. Magn Reson Med 76:1375-1387
Chow, Kelvin; Yang, Yang; Shaw, Peter et al. (2016) Robust free-breathing SASHA T1 mapping with high-contrast image registration. J Cardiovasc Magn Reson 18:47
Coleman, G Cameron; Shaw, Peter W; Balfour Jr, Pelbreton C et al. (2016) Prognostic Value of Myocardial Scarring on CMR in Patients With Cardiac Sarcoidosis: A Systematic Review and Meta-Analysis. JACC Cardiovasc Imaging :
Pan, Jonathan A; Salerno, Michael (2016) Clinical Utility and Future Applications of PET/CT and PET/CMR in Cardiology. Diagnostics (Basel) 6:
Gonzalez, Jorge A; Lipinski, Michael J; Flors, Lucia et al. (2015) Meta-Analysis of Diagnostic Performance of Coronary Computed Tomography Angiography, Computed Tomography Perfusion, and Computed Tomography-Fractional Flow Reserve in Functional Myocardial Ischemia Assessment Versus Invasive Fractional Flow Reserve. Am J Cardiol 116:1469-78
Kuruvilla, Sujith; Janardhanan, Rajesh; Antkowiak, Patrick et al. (2015) Increased extracellular volume and altered mechanics are associated with LVH in hypertensive heart disease, not hypertension alone. JACC Cardiovasc Imaging 8:172-80
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

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