Directed intervention (coronary artery bypass surgery; intra-coronary stent placement) in the treatment of coronary artery disease is costly in patient morbidity, mortality and U.S. health care dollars. Methodologies that can improve the accuracy of application of these modalities deserve aggressive investigation. Magnetic Resonance Imaging (MRI) combined with radiofrequency tissue-tagging can non-invasively lay down transmural crosshatched grids in the myocardium that can be tracked throughout the cardiac cycle by MRI. Computer-based analysis techniques, developed in our laboratory, can track the grid intersections and generate regional point displacements and transmural 3D myocardial """"""""strain"""""""" maps. Strain is a normalized description of direction and degree of myocardial point movement. From these 3D strain maps we can determine the direction of principal strain vectors at every point throughout the left ventricle. We hypothesize, based on our preliminary data, that the direction of these vectors is very sensitive to the regionally-varying influence of coronary artery disease on contractile function and can introduce an unprecedented level of objective quantification and accurate regional localization of ischemia. These strain vectors will be utilized in a familiar testing algorithm: 1) baseline strain vector determinations are made, and 2) repeat determinations are made after low-dose Dobutamine. Areas with abnormal resting vectors are examined at low dose Dobutamine to see if they """"""""recruit,"""""""" suggesting viability and potential for benefit from coronary intervention. The hypotheses do not test this well established algorithm, but rather the capability of these techniques to bring accurate regional localization and objective quantification to the output data from the algorithm, and thus improve accuracy of application of directed coronary intervention.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
5R01HL069967-02
Application #
6779869
Study Section
Surgery and Bioengineering Study Section (SB)
Program Officer
Buxton, Denis B
Project Start
2003-08-01
Project End
2007-07-31
Budget Start
2004-08-01
Budget End
2005-07-31
Support Year
2
Fiscal Year
2004
Total Cost
$267,750
Indirect Cost
Name
Washington University
Department
Surgery
Type
Schools of Medicine
DUNS #
068552207
City
Saint Louis
State
MO
Country
United States
Zip Code
63130
Lindman, Brian R; Liu, Qi; Cupps, Brian P et al. (2017) Heterogeneity of systolic dysfunction in patients with severe aortic stenosis and preserved ejection fraction. J Card Surg 32:454-461
Henn, Matthew C; Cupps, Brian P; Kar, Julia et al. (2015) Quantifying ""normalized"" regional left ventricular contractile function in ischemic coronary artery disease. J Thorac Cardiovasc Surg 150:240-6
Henn, Matthew C; Lawrance, Christopher P; Kar, Julia et al. (2015) Dilated Cardiomyopathy: Normalized Multiparametric Myocardial Strain Predicts Contractile Recovery. Ann Thorac Surg 100:1284-91
Maniar, Hersh S; Brady, Beckah D; Lee, Urvi et al. (2014) Early left ventricular regional contractile impairment in chronic mitral regurgitation occurs in a consistent, heterogeneous pattern. J Thorac Cardiovasc Surg 148:1694-9
Brady, Beckah D; Knutsen, Andrew K; Ma, Ningning et al. (2012) MRI-based multiparametric strain analysis predicts contractile recovery after aortic valve replacement for aortic insufficiency. J Card Surg 27:415-22
Knutsen, Andrew K; Ma, Ningning; Taggar, Ajay K et al. (2012) Heterogeneous distribution of left ventricular contractile injury in chronic aortic insufficiency. Ann Thorac Surg 93:1121-7
Lawton, Jennifer S; Cupps, Brian P; Knutsen, Andrew K et al. (2011) Magnetic resonance imaging detects significant sex differences in human myocardial strain. Biomed Eng Online 10:76
Singh, Gautam K; Cupps, Brian; Pasque, Michael et al. (2010) Accuracy and reproducibility of strain by speckle tracking in pediatric subjects with normal heart and single ventricular physiology: a two-dimensional speckle-tracking echocardiography and magnetic resonance imaging correlative study. J Am Soc Echocardiogr 23:1143-52
Cupps, Brian P; Taggar, Ajay K; Reynolds, Lina M et al. (2010) Regional myocardial contractile function: multiparametric strain mapping. Interact Cardiovasc Thorac Surg 10:953-7
Joseph, Susan; Moazami, Nader; Cupps, Brian P et al. (2009) Magnetic resonance imaging-based multiparametric systolic strain analysis and regional contractile heterogeneity in patients with dilated cardiomyopathy. J Heart Lung Transplant 28:388-94

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