Given the short supply of donor hearts, for many HF patients the only life-prolonging therapy is a surgically implanted left ventricular assist device (LVAD), either as a 'bridge-to-transplantation' or 'destination therapy.' Unfortunately, a frequent and often deadly complication of LVAD therapy is right HF (RHF), which is common (~25%) in patients after LVAD implantation. RHF is associated with decreased quality of life, more frequent hospitalizations and increased mortality. While several RHF risk scores are available, including those using echocardiography and right heart catheterization (RHC) metrics, most are derived from retrospective analyses of pilot cohorts. Moreover, predictive performance of these risk scores has been disappointing, with limited clinical utility. Factors predicting RHF following LVAD implantation remain unknown, in part due to difficulty in characterizing the right ventricle (RV), which has complex geometry and thin walls. Cardiac MRI is arguably the best imaging test for a comprehensive evaluation of RV pathophysiology. Compared with echocardiography, MRI provides clearer visualization of the right side of the heart and enables more comprehensive characterization of RV pathophysiology. Imaging evaluation beyond cardiac function is important since recent data suggests RV contractile reserve in HF may depend on presence and extent of myocardial fibrosis. Unfortunately, standard cardiac MRI is likely to produce low diagnostic yield in LVAD candidates, because approximately 80% of them have an implantable cardioverter defibrillator (ICD) and most of them have dyspnea, both of which causes severe image artifacts. To bridge this major gap in cardiac MRI technology, this high-risk, high-reward proposal seeks to develop free-breathing wideband cardiac MRI methods for predicting RHF in LVAD candidates. The objectives of this proposal are: (a) to develop free-breathing wideband cardiac MRI methods for a comprehensive assessment of RV pathophysiology (fibrosis, function, tricuspid valvular regurgitation) in LVAD candidates and (b) to evaluate whether pre-LVAD implant metrics measured by wideband cardiac MRI methods are associated with post-LVAD hemodynamic metrics of RV dysfunction. The long-term goal of this proposal is to improve risk stratification for RHF among advanced HF patients undergoing LVAD evaluation.
|Effective start/end date||7/1/19 → 6/30/22|
- American Heart Association (19IPLOI34760317)
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