Congenital heart disease (CHD) is the most common birth defect, affecting 1.2% of all live births. Imaging plays a major role in managing CHD but remains challenging for evaluating complex cardiac and vascular abnormalities across a wide range of age and habitus. To address these limitations, the PIs have developed cardiovascular 4D flow MRI which can measure complex 3D blood flow in-vivo, a task difficult or impossible to obtain with other imaging strategies. Recent efforts have focused on two forms of CHD: 1) bicuspid aortic valve (BAV) which is the most common form of CHD, and 2) single ventricle physiology (SVP), one of the most severe forms of CHD. Our 4D flow MRI studies have successfully identified new hemodynamic biomarkers to better characterize CHD. We were the first to establish a physiologic link between aberrant 3D blood flow, elevated wall shear stress (WSS), aortopathy phenotype, and aortic wall tissue degeneration on histopathology in patients with BAV. In patients with SVP, our findings demonstrated relationships between surgical correction strategies and flow distribution to the lungs, a known factor implicated in SVP outcome. We have achieved successful clinical translation at Northwestern, where 4D flow MRI is now used as a clinical tool in diagnostic MRI exams for patients with CHD and aortic disease. Over the past four years, the PIs have assembled one of the largest 4D MRI databases with over 2500 patient exams. For this renewal application, we identified a need to increase the dynamic range of 4D MRI flow sensitivity to account for data complexity (3D + time) and the wide age range in CHD by a combination of dual-venc flow encoding, compressed sensing, and SSFP imaging. Second, three is a need for longitudinal studies to identify predictors of BAV and SVP outcome. Third, making these unique but complex 4D MRI data sets and analysis tools more widely available to the greater research community is challenging. In addition, no automated methods currently exist for advanced processing such as atlas based analysis across large cohorts. Analysis is thus time consuming and requires manual interactions (e.g. 3D vessel segmentation) which limits reproducibility and translation. To address this need, an established Northwestern data archival and pipeline processing resource based on remote high-performance computing clusters (NUNDA) will be utilized for standardized data archival, sharing, and pipeline processing of 4D MRI data. This platform will provide the unique opportunity to utilize annotated data available in the 4D MRI database (>1300 BAV, SVP, and control 4D MRI data analyzed in the initial funding cycle) for application of machine learning concepts to establish (semi-)automated 4D MRI analysis workflows in NUNDA. Thus, the renewal application for this study aims to 1) develop a rapid (15 min) non-contrast 4D MRI for clinical translation, 2) leverage the existing large 4D MRI database to identify 4D MRI metrics predictive of long-term (> 5 years) CHD patient outcome, and 3) establish a remote NUNDA platform for 4D MRI data sharing and automated analysis across large cohorts.

Public Health Relevance

Our goal is to develop non-contrast 4D MRI, a new diagnostic test to achieve an improved assessment for the most common and one of the most severe forms of congenital heart disease: bicuspid aortic valve and single ventricle physiology. We will leverage an existing large 4D MRI database to allow for long-term 5-8-year follow-up to establish new measures for improved outcome prediction and therapy management for patients with bicuspid aortic valve and single ventricle physiology. A comprehensive data archive will be established to allow for the dissemination of the 4D MRI data, analysis tools, and study results to the greater research community.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
5R01HL115828-07
Application #
9663985
Study Section
Special Emphasis Panel (ZRG1)
Program Officer
Evans, Frank
Project Start
2012-09-01
Project End
2022-03-31
Budget Start
2019-04-01
Budget End
2020-03-31
Support Year
7
Fiscal Year
2019
Total Cost
Indirect Cost
Name
Northwestern University at Chicago
Department
Radiation-Diagnostic/Oncology
Type
Schools of Medicine
DUNS #
005436803
City
Chicago
State
IL
Country
United States
Zip Code
60611
Bollache, Emilie; Guzzardi, David G; Sattari, Samaneh et al. (2018) Aortic valve-mediated wall shear stress is heterogeneous and predicts regional aortic elastic fiber thinning in bicuspid aortic valve-associated aortopathy. J Thorac Cardiovasc Surg 156:2112-2120.e2
Shen, Daming; Edelman, Robert R; Robinson, Joshua D et al. (2018) Single-Shot Coronary Quiescent-Interval Slice-Selective Magnetic Resonance Angiography Using Compressed Sensing: A Feasibility Study in Patients With Congenital Heart Disease. J Comput Assist Tomogr 42:739-746
Robinson, Joshua D; Rose, Michael J; Joh, Maria et al. (2018) 4-D flow magnetic-resonance-imaging-derived energetic biomarkers are abnormal in children with repaired tetralogy of Fallot and associated with disease severity. Pediatr Radiol :
Raghav, Vrishank; Barker, Alex J; Mangiameli, Daniel et al. (2018) Valve mediated hemodynamics and their association with distal ascending aortic diameter in bicuspid aortic valve subjects. J Magn Reson Imaging 47:246-254
Bollache, Emilie; Barker, Alex J; Dolan, Ryan Scott et al. (2018) k-t accelerated aortic 4D flow MRI in under two minutes: Feasibility and impact of resolution, k-space sampling patterns, and respiratory navigator gating on hemodynamic measurements. Magn Reson Med 79:195-207
Bollache, Emilie; Fedak, Paul W M; van Ooij, Pim et al. (2018) Perioperative evaluation of regional aortic wall shear stress patterns in patients undergoing aortic valve and/or proximal thoracic aortic replacement. J Thorac Cardiovasc Surg 155:2277-2286.e2
Garcia, Julio; van der Palen, Roel L F; Bollache, Emilie et al. (2018) Distribution of blood flow velocity in the normal aorta: Effect of age and gender. J Magn Reson Imaging 47:487-498
Ma, Liliana E; Vali, Alireza; Blanken, Carmen et al. (2018) Altered Aortic 3-Dimensional Hemodynamics in Patients With Functionally Unicuspid Aortic Valves. Circ Cardiovasc Imaging 11:e007915
Geiger, Julia; Rahsepar, Amir A; Suwa, Kenichiro et al. (2018) 4D flow MRI, cardiac function, and T1 -mapping: Association of valve-mediated changes in aortic hemodynamics with left ventricular remodeling. J Magn Reson Imaging 48:121-131
Hill, Kevin D; Frush, Donald P; Han, B Kelly et al. (2017) Radiation Safety in Children With Congenital and Acquired Heart Disease: A Scientific Position Statement on Multimodality Dose Optimization From the Image Gently Alliance. JACC Cardiovasc Imaging 10:797-818

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