Detection of chronic heart failure in children with congenital heart disease with innovative ultrasound techniques (NKG.6466)

Project nummer: nkg6466

Omschrijving van het onderzoek

Research
In children with a congenital heart disease, functional malformations which may lead to chronic heart failure are often present. Although echocardiography is a well-established clinical tool in pediatric cardiology, it does not provide quantitative information on locally disturbed mechanical properties of the myocard nor on its possible cause i.e. the formation of fibrosis. Furthermore, the presently available two-dimensional information is not sufficient to assess the exact geometry of the heart with congenital malformations.

The primary focus is on three/four-dimensional functional characterization of the myocard using ultrasound strain(-rate) imaging and ultrasound spectroscopy. The first parameter provides the cyclic deformation of the myocardium, the latter parameter is associated with changes in the structural composition of the myocard. The innovation of the project is that the strain(-rate) will be determined in three dimensions versus time using the rf-signal and will be combined with spectroscopy. Estimation of the three components of the strain(-rate) vector is not described in literature but is required since the heart is a complex structure composed of non-isotropic muscular tissue, requiring knowledge of the strain in all dimensions.

The second focus is on real-time three-dimensional imaging of the heart. Software for automated myocardial boundary detection and segmentation will be developed and validated. This technique will optimize the identification and functional quantification of congenital malformations as well as assess the translation and rotation of the heart. Combination of strain(-rate), spectroscopy, and segmentation in four dimensions (three dimensions versus time) may provide a method to identify the time-point at which reversible hypertrophy changes into irreversible damage due to fibrosis formation and may be used to decide on timely treatment or intervention, thus preventing heart failure. The final goal is to evaluate the developed techniques in selected patient groups.

Utilization
Three-dimensional assessment of strain, spectroscopy and geometry requires a real-time three-dimensional ultrasound system. Such a system is introduced by Philips Medical System (PMS). This system uses a matrix array probe that in contrary to other commercially available systems is fully wired making it perfectly suited for four-dimensional strain(-rate) imaging. PMS participates in the user committee, and financially contributes in this project by supplying and real time 3D ultrasound machine equipped with an rf-interface to enable rf-based strain estimation and spectroscopy.

The clinical utilization is covered by the pediatric cardiologists and the thorax surgeons of the Children's Heart Center. A pediatric cardiologist and a heart surgeon will start a PhD study and these studies will be partly performed in the framework of this proposal. Furthermore, the department of Cardiology is also highly interested in a non-invasive method to quantify the composition and function of the myocard to prevent heart failure. The departments of Cardiology and Thorax Surgery of the UMC St Radboud Heart Center are also financially contributing to this project.

Currently, no other group worldwide has presented or published on real-time three-dimensional strain imaging and spectroscopy of the heart. The collaboration with PMS and the clinicians of the Heart Centers, together with the availability of an animal model to validate the techniques and the evaluation in children with congenital heart disease, will increase the rate of success and may stimulate the implementation in commercial ultrasound machines.

More Information
More information can be found on www.elastography.eu

Gebruikers

Five companies are involved in this project.

Projectleider

Dr.ir. C.L. de Korte

Universitair Medisch Centrum St. Radboud
Kinderziekenhuis
Klinisch Fysisch Laboratorium 833

Postbus 9101
6500 HB Nijmegen

Status van het project

Gestart	: 01-11-2004
Einddatum	: 01-12-2008

Trefwoorden

Animal study, Children, Clinical evaluation, Congenital, Echocardiography, Heart disease, Segmentation, Strain imaging, Tissue characterization.

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