Congestive heart failure (CHF) affects over 5 million Americans and is a major cause of death and the most common reason for hospitalization. Nearly fifty percent of CHF patients will die within 5 years of diagnosis, which is a higher mortality than most forms of cancer. Cardiac resynchronization therapy (CRT) has emerged as a promising therapy for CHF patients with dyssynchrony and has been shown in trials to significantly improve symptoms and cardiac pump efficiency when pacemaker leads are placed successfully. Today, X-ray imaging alone is used to guide placement of pacemaker leads for CRT, but this modality provides little functional and anatomic information to the physician. Lead placement is performed by steering relatively """"""""blindly"""""""" which contributes to a procedural failure rate of 20% and may explain a non-response rate of more than 30%. On the other hand, MRI offers unique soft tissue contrast without the use of ionizing radiation for depicting coronary vein morphology, quantifying myocardial dyssynchrony, and identifying scar tissue. It is widely believed that these elements are key determinants of clinical outcomes for CRT and that they should be used for patient selection, procedural planning, and guidance of CRT. The objective of this project is to develop an """"""""X-ray fused with MR"""""""" (XFM) image guidance system for integrating pre-procedural MR-derived vein imaging, mechanical dyssynchrony and myocardial viability with intra-procedural X-ray images to guide CRT procedures. These measures will allow the physician to directly relate the positions of the coronary vein and left ventricular leads with the surrounding soft tissue characteristics in real-time during lead placement. We hypothesize that this XFM guidance system will facilitate more effective placement of the pacemaker leads, ultimately leading to an increase in CRT responder rates. This project will be divided into three main Specific Aims: (1) to develop a cardiac MR imaging methodology for creating a single 3D representation of coronary vein anatomy, mechanical dyssynchrony, and myocardial viability (2) to develop an XFM interventional guidance system that provides real-time overlay of MR derived measures on live X-ray images with compensation of respiratory motion in the EP lab (3) to validate XFM CRT system with in vivo animal experiments followed by first in human clinical study. This project will bring together unique MR imaging methods and state of the art interventional image guidance to address one of the leading causes of death in the United States.

Public Health Relevance

Congestive heart failure (CHF) affects over 5 million Americans and is a major cause of death and the most common reason for hospitalization. Cardiac resynchronization therapy (CRT) has emerged as a promising therapy for CHF patients with dyssynchrony and has been shown in trials to significantly improve symptoms and cardiac pump efficiency when pacemaker leads are placed successfully. Today, X-ray imaging alone is used to guide placement of pacemaker leads for CRT, but this modality provides little functional and anatomic information to the physician, which may explain a non-response rate of more than 30%. The objective of this project is to develop an """"""""X-ray fused with MR"""""""" (XFM) image guidance system for integrating pre-procedural MRI-derived vein imaging, mechanical dyssynchrony and myocardial viability with intra- procedural X-ray images to guide CRT procedures, with the goal of improving patient response rates.

Agency
National Institute of Health (NIH)
Institute
National Institute of Biomedical Imaging and Bioengineering (NIBIB)
Type
Research Project (R01)
Project #
5R01EB008743-03
Application #
8037169
Study Section
Biomedical Imaging Technology Study Section (BMIT)
Program Officer
Krosnick, Steven
Project Start
2009-05-01
Project End
2013-02-28
Budget Start
2011-03-01
Budget End
2012-02-29
Support Year
3
Fiscal Year
2011
Total Cost
$628,777
Indirect Cost
Name
Beth Israel Deaconess Medical Center
Department
Type
DUNS #
071723621
City
Boston
State
MA
Country
United States
Zip Code
02215
Nakamori, Shiro; Bui, An H; Jang, Jihye et al. (2018) Increased myocardial native T1 relaxation time in patients with nonischemic dilated cardiomyopathy with complex ventricular arrhythmia. J Magn Reson Imaging 47:779-786
Nakamori, Shiro; Ismail, Haisam; Ngo, Long H et al. (2017) Left ventricular geometry predicts ventricular tachyarrhythmia in patients with left ventricular systolic dysfunction: a comprehensive cardiovascular magnetic resonance study. J Cardiovasc Magn Reson 19:79
Nakamori, Shiro; Alakbarli, Javid; Bellm, Steven et al. (2017) Native T1 value in the remote myocardium is independently associated with left ventricular dysfunction in patients with prior myocardial infarction. J Magn Reson Imaging 46:1073-1081
Basha, Tamer A; Akçakaya, Mehmet; Liew, Charlene et al. (2017) Clinical performance of high-resolution late gadolinium enhancement imaging with compressed sensing. J Magn Reson Imaging 46:1829-1838
Bellm, Steven; Basha, Tamer A; Shah, Ravi V et al. (2016) Reproducibility of myocardial T1 and T2 relaxation time measurement using slice-interleaved T1 and T2 mapping sequences. J Magn Reson Imaging 44:1159-1167
Kato, Shingo; Foppa, Murilo; Roujol, Sébastien et al. (2016) Left ventricular native T1 time and the risk of atrial fibrillation recurrence after pulmonary vein isolation in patients with paroxysmal atrial fibrillation. Int J Cardiol 203:848-54
Kato, Shingo; Nakamori, Shiro; Roujol, Sébastien et al. (2016) Relationship between native papillary muscle T1 time and severity of functional mitral regurgitation in patients with non-ischemic dilated cardiomyopathy. J Cardiovasc Magn Reson 18:79
Basha, Tamer A; Bellm, Steven; Roujol, Sébastien et al. (2016) Free-breathing slice-interleaved myocardial T2 mapping with slice-selective T2 magnetization preparation. Magn Reson Med 76:555-65
Kato, Shingo; Nakamori, Shiro; Bellm, Steven et al. (2016) Myocardial Native T1 Time in Patients With Hypertrophic Cardiomyopathy. Am J Cardiol 118:1057-62
Jang, Jihye; Bellm, Steven; Roujol, Sébastien et al. (2016) Comparison of spoiled gradient echo and steady-state free-precession imaging for native myocardial T1 mapping using the slice-interleaved T1 mapping (STONE) sequence. NMR Biomed 29:1486-96

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