This is an application for competitive renewal of our project entitled """"""""Contrast MRI and Chronic Myocardial Injury in Humans"""""""", which yielded many of the original papers in delayed-enhancement"""""""" MRI (DE-MRI), a technique that is now considered a fundamental component of the Cardiac MRI examination and used world-wide to evaluate patients with heart disease. Despite the successes, there remain crucial limitations in the evidence base and in the technique itself. First, very few prognostic studies have been performed, and as such, there is a paucity of evidence linking DE-MRI findings with patient outcome. Yet, prognostic studies are the bedrock of evidence-based clinical medicine and these will be vital in determining the exact role of DE-MRI in assisting patient management decisions. Second, DE-MRI exhibits excellent contrast between infarcted and normal myocardium;however, the contrast between infarcted myocardium and the blood pool (both of which are bright) is frequently suboptimal. Since a large proportion of infarctions caused by coronary heart disease are subendocardial, it is often difficult to detect small infarcts or, even if detected, to assess the precise size of the infarct. Given these limitations, we have identified two important """"""""next steps"""""""" that we will tackle as part of our continuing project. First, we will aim to establish the prognostic implications of the DE-MRI findings. We propose to study patients with left ventricular dysfunction due to cardiomyopathy, a group at increased risk for sudden death (Aim 1). We hypothesize that an assessment of myocardial scarring by DE-MRI will provide additional prognostic information compared with a traditional assessment, including left ventricular ejection fraction. Second, we have developed a novel """"""""dark-blood"""""""" DE-MRI technique (FIDDLE), which improves the detection of subendocardial infarcts. Our goal will be to optimize this technique in an animal model of myocardial infarction (MI), and then to compare this technique with conventional DE-MRI in a study of patients with documented non-Q-wave MI, which are often small and subendocardial (Aims 2 and 3). We hypothesize that FIDDLE will improve sensitivity for detecting MI, without reducing specificity. Given the worldwide epidemic of cardiovascular disease (30% of global deaths), a noninvasive technique that could improve the detection, risk stratification, and management of patients with heart disease would represent a significant advance. Accordingly, we believe that the results of this project could have a large clinical impact.

Public Health Relevance

Delayed-enhancement"""""""" MRI (DE-MRI), a technique that is now considered a fundamental component of the Cardiac MRI examination, is used world-wide to evaluate patients with heart disease. Despite the successes, there remain crucial limitations in the evidence base and in the technique itself. This project aims to establish the prognostic implications of the DE-MRI findings and proposes a new technique to improve the detection of subendocardial infarcts. Given the worldwide epidemic of cardiovascular disease (30% of global deaths), a noninvasive technique that could improve the detection, risk stratification, and management of patients with heart disease would represent a significant advance. Accordingly, we believe that the results of this project could have a large clinical impact.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
5R01HL064726-09
Application #
8451402
Study Section
Special Emphasis Panel (ZRG1-SBIB-P (02))
Program Officer
Buxton, Denis B
Project Start
2000-04-01
Project End
2015-03-31
Budget Start
2013-04-01
Budget End
2014-03-31
Support Year
9
Fiscal Year
2013
Total Cost
$473,848
Indirect Cost
$170,099
Name
Duke University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
044387793
City
Durham
State
NC
Country
United States
Zip Code
27705
Romano, Simone; Judd, Robert M; Kim, Raymond J et al. (2018) Prognostic Implications of Mitral Annular Plane Systolic Excursion in Patients with Hypertension and a Clinical Indication for Cardiac Magnetic Resonance Imaging: A Multicenter Study. JACC Cardiovasc Imaging :
Romano, Simone; Judd, Robert M; Kim, Raymond J et al. (2018) Feature-Tracking Global Longitudinal Strain Predicts Death in a Multicenter Population of Patients With Ischemic and Nonischemic Dilated Cardiomyopathy Incremental to Ejection Fraction and Late Gadolinium Enhancement. JACC Cardiovasc Imaging 11:1419-1429
Romano, Simone; Judd, Robert M; Kim, Raymond J et al. (2018) Left Ventricular Long-Axis Function Assessed with Cardiac Cine MR Imaging Is an Independent Predictor of All-Cause Mortality in Patients with Reduced Ejection Fraction: A Multicenter Study. Radiology 286:452-460
Kim, Han W; Rehwald, Wolfgang G; Jenista, Elizabeth R et al. (2018) Dark-Blood Delayed Enhancement Cardiac Magnetic Resonance of Myocardial Infarction. JACC Cardiovasc Imaging 11:1758-1769
Klem, Igor; Heiberg, Einar; Van Assche, Lowie et al. (2017) Sources of variability in quantification of cardiovascular magnetic resonance infarct size - reproducibility among three core laboratories. J Cardiovasc Magn Reson 19:62
Romano, Simone; Judd, Robert M; Kim, Raymond J et al. (2017) Association of Feature-Tracking Cardiac Magnetic Resonance Imaging Left Ventricular Global Longitudinal Strain With All-Cause Mortality in Patients With Reduced Left Ventricular Ejection Fraction. Circulation 135:2313-2315
Jenista, Elizabeth R; Rehwald, Wolfgang G; Chaptini, Nayla H et al. (2017) Suppression of ghost artifacts arising from long T1 species in segmented inversion-recovery imaging. Magn Reson Med 78:1442-1451
Smulders, Martijn W; Bekkers, Sebastiaan C A M; Kim, Han W et al. (2015) Performance of CMR Methods for Differentiating Acute From Chronic MI. JACC Cardiovasc Imaging 8:669-79
Kim, Han W; Van Assche, Lowie; Jennings, Robert B et al. (2015) Relationship of T2-Weighted MRI Myocardial Hyperintensity and the Ischemic Area-At-Risk. Circ Res 117:254-65
White, James A; Kim, Han W; Shah, Dipan et al. (2014) CMR imaging with rapid visual T1 assessment predicts mortality in patients suspected of cardiac amyloidosis. JACC Cardiovasc Imaging 7:143-56

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