2015-08-012024-05-13https://scholars.lib.ntu.edu.tw/handle/123456789/649874摘要：本計畫延續過去兩年的成果，主要的目的在利用非侵襲性的影像及電生理檢查，找尋心因性猝死的高危險心臟衰竭病人。心臟衰竭而死亡的病人中，約有一半的死亡主因是心室頻脈及顫動。如何找尋高危險的心臟衰竭病人而讓體內心臟去顫器的植入能發揮最大的效果，以達到初級預防的目的，一直是個重要的課題。就初級預防的角度來說，目前的臨床指引是以左心室射出分率(left ventricular ejection fraction)來挑選高危險群，然而大約只有13%的心因性猝死病患左心室射出份率符合標準。越來越多的研究證實，心臟核磁共振影像除了能正確的評估心臟功能外，亦能透過定量心肌核心疤痕(core scar)及周邊的灰色地帶(gray zone)的大小準確的預測心臟衰竭病人的預後。然這一類型的分析，往往僅著重在疤痕及灰色地帶大小的分析而不是疤痕及灰色地帶這些受傷心肌組織“質＂的分析。在未來的三年中，我們將組織一個包括臨床心臟電生理，臨床影像醫學，數據分析及數學模型模擬的專家團隊。我們計畫結合新的影像指標，非侵襲性電生理檢查及數據分析方法，研究心臟衰竭病患心肌疤痕組織的影像及電生理功能。我們將利用核磁共振測量心肌瀰漫性纖維化(diffuse fibrosis)及脂肪含量(adiposity)等心肌受損的新指標，並結合新的影像分析方法，更正確的找出心因性猝死的高危險心臟衰竭病人。<br> Abstract: The current project is an extension of our works in previous 2 years. Our main goal isto used non-invasive image and electrophysiology examinations to identify heart failure(HF) patients at risk for sudden cardiac death (SCD). About half of the patients with HFdied from ventricular tachycardia or ventricular fibrillation (VT/VF). It is an importantissue to identify the real high risk patients to optimize the benefit of implantingimplantable cardioverter defibrillator (ICD) for the primary prevention of SCD. Forprimary prevention, the current guideline chooses high risk patients by their leftventricular ejection fraction (LVEF). However, only 13% of the SCD fulfilled thecriteria. Recently, more and more studies have shown the cardiac magnetic resonanceimage (CMRI) could not only correctly evaluate the heart function but also couldprecisely predict the prognosis of HF patients through quantification of the sizes ofmyocardial core scar and gray zone. One major limitation is that this kind of analysisjust focuses on the sizes of core scar and gray zone rather than the quality analysis.In the future three years, we will launch a team including clinical cardiologist,radiologist and specialists in signal analysis. We plan to combine new CMRI parameters,noninvasive electrophysiology examinations and new signal analytic technique toinvestigate the myocardial scar image and electrophysiology function. We will useCMRI to measure several novel myocardial injury parameters including diffuse fibrosisand intramyocardial adiposity. Also we will combine new signal analysis method tomore accurately identify real high risk HF patients for SCD.心臟衰竭核磁共振心室頻脈心室顫動congestive heart failuremagnetic resonance imageventricular tachycardiaventricular fibrillation