The Assessment Of Myocardial Viability Based On CTA/MRI Hybrid Models

The HYBRIDHEART study is a prospective, observational study that will be conducted in the Laboratory of Advanced Research in Cardiac Multimodal Imaging of Cardio Med Medical Center Tîrgu Mureş, Romania.

The project will include 100 subjects with documented ST Segment elevation myocardial infarction at 30 days prior to study enrollment. The level of inflammatory biomarkers will be express using hs-CRP levels at day 1 and day 5 post the acute event. All the subjects will undergo coronary computer tomography angiography (CCTA), magnetic resonance (MRI), 3D contrast enhancement echocardiography, speckle tracking echocardiography at the moment of the inclusion. Also, venous blood samples will be collected for the determination of the level of hs-CRP and myocardial necrosis biomarkers such as I Troponin, myocardial fraction of creatine kinase (CK-MB).

The imagistic acquisitions obtained from all the techniques used, will be processed using a supercomputer set up with computational simulations applications for the myocardial kinetics. All the MRI images will be analyzed using Medis Q-mass software in order to quantify the myocardial fibrosis, and the CCTA images will be analyzed using SyngoVia. Frontier software, for the plaques evaluation. The images will be superposed obtaining hybrid CCTA-MRI images that will be analyzed in order to correlate the degree of plaque vulnerability, the percent of myocardial scar, the percent of viable myocardial tissue, calculating the total Calcium Scoring, Syntax score.

The study will be conducted over a period of 2 years, in which the subjects will be examined at the moment of inclusion and during the follow-up visits. Will be performed the follow up of the subjects at 1, 3 and 6 months and 1 year after the inclusion period. At 1 month follow up the subjects will be examined, will be performed echocardiography. Moreover during follow up will be done telephonic visits with target questions . MACE rate will be assessed at 6 month follow-up and 1 year follow up visits.

Study objectives:

Primary: to develop new imagistic markers for a complex evaluation of the myocardial viability, by superposing computed tomographic angiographic polar maps of the myocardium with MRI contrast enhancement maps in subjects with myocardial infarction.

Secondary: to evaluate the association of the percent of viable myocardium with the level of inflammatory markers. To correlate the plaque vulnerability markers with the percent of myocardial fibrosis, the inflammatory status of the subjects, left ventricular function, ischemic time and the rate of MACE, Calcium Score, Syntax score

Study timeline:

Baseline (day0) Obtain a written consent from the participants on study consent form. Verify inclusion/exclusion criteria Assess the demographical data of the participants, medical history, possible known allergies, medication history, alcohol, tobacco use history Physical examination record Blood pressure record 12-lead ECG Collect venous blood samples Performing CCTA, MRI, Speckle Tracking Echocardiography using standard protocols

Visit 1 (month 1) Physical examination record 12-lead ECG Blood pressure record Transthoracic Echocardiography

Visit 2 (month 3) Telephone visit with target questions, all the answers recorded in study forms.

Visit 3 (month 6) End point evaluation 12-lead ECG Blood pressure record Transthoracic Echocardiography

Visit 4 (12 months) End point evaluation 12-lead ECG Blood pressure record Transthoracic Echocardiography Performing CCTA

Study procedures:

Clinical examinations 12 lead ECG Laboratory assessment for the evaluation of the level of hs-CRP and myocardial necrosis biomarkers (I Troponin, CK-MB) Speckle Tracking echocardiography with analyzing the myocardial strain, myocardial velocities, left ventricular function 128-multislice CCTA with the evaluation of the Calcium Scoring (total and local) , identifying the coronary stenosis, evaluation of the plaque vulnerability degree, assess polar maps of the myocardium.

MRI for the evaluation of the percentage of myocardial scar, also the percentage of the viable myocardial tissue using contrast late enhancement sequences, measuring myocardial fibrosis using Q-mass software.

Data collection:

A dedicated database will be created, including all the demographical data and data regarding the acute myocardial infarction, such as: infarct location, time of ischemia, ECG changes, levels of the necrosis markers, hs-CPR, MRI findings, CCTA findings, speckle tracking parameters.