Heartfailurewithpreservedejectionfraction(HFpEF)iscurrentlybeingstudiedintenselyasseveral largetrialsofdrugtherapieshavefailedtobenefitpatients.Bettercharacterizationofthesepatientsis important, and there are open questions regarding microvascular disease and remodeling in the HFpEF population. New MRI methods could be ideal to better characterize and understand HFpEF anditsresponsetotreatments.Thisprojectseekstodevelop,evaluateandapplynewMRImethods forhigh-endperfusionimaging.Thesemethodswillestimateendo/epiratiosacrossthecardiaccycle in free-breathing studies, which will be used along with other new MRI measurements and blood biomarkers to provide new information about microvascular disease. This is of particular value for assessingHFpEF.
The aims and methods of this project are to (1) develop and compare new 2D radial simultaneous multi-slice (SMS) and 3D stack-of-stars (SoS) acquisitions and reconstruction methods for quantitative perfusion measurements. (2) To validate the new 2D radial SMS and 3D SoS free- breathing methods in an animal model of HFpEF, and in humans to further characterize the new methods by comparison to a more standard MRI method and to dynamic PET. (3) To use the methods along with fibrosis quantitation and other MRI measures to characterize perfusion and fibrosischangesovertimeinpatientswithHFpEF.Thiswillgivemoreinsightintonon-invasiveMRI- basedperfusionandfibrosisbiomarkersandhowtheycomplementotherbiomarkersandgiveinsight intodifferentsubtypesofHFpEF. The relevance to public health is that HFpEF is a leading cause of disability and death and no effectivetreatmentisknown.Thedevelopmentanduseofaccurateandrepeatablemeasurementsof perfusionandtheircombinationwithfibrosisquantitationwillleadtoacceleratedevaluationofclinical therapies.Theprojectwillalsoprovidenewtoolsandknowledgeforbettermanagementofpatients with HFpEF. The proposed approach will be extended to better understand a range of cardiac diseases.
Half of all people with heart failure have heart failure with preserved ejection fraction (HFpEF). Unlike heart failure with reduced ejection fraction (HFrEF), many trials have been performed to find an effective treatment, with little success to date. This proposal offers new methods using MRI to characterize people with HFpEF. If such measurements can be made more accurately, this will allow for more informed treatments and monitoring of HFpEF and will improve public health.
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