2014-08-012024-05-13https://scholars.lib.ntu.edu.tw/handle/123456789/649949摘要：因心臟衰竭而死亡的病人中，約有一半是死亡的主因是心室頻脈及顫動。治療心室頻脈及顫動最有效地方法就是給予心臟電擊。過去許多研究證實，植入體內心臟去顫器能有效的減少心臟衰竭病人的死亡率。然而，如果全面性的針對心臟衰竭的病人植入去顫器，不僅造成經濟沈重的負擔，去顫器本身亦可因為錯誤的電擊而增加病人的死亡率。所以，在臨床上利用非侵襲性的方法尋找高危險的心臟衰竭病患，一直是心臟學領域一個非常重要的課題。雖然臨床上已有許多非侵襲性的評估工具，然而他們的缺點在敏感度不佳。近來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忽視一個事實，那就是引發心室頻脈的主因，是核心疤痕內傳導緩慢，形狀狹長的心肌組織(傳導通道，conductive channel)。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，以新的影像分析方法結合電生理的數學模型，研究心臟衰竭病患心肌疤痕組織的影像及電生理功能，進而發展一個強而有力的非侵襲性的心臟影像-電生理功能評估工具。我們也將以侵襲性的電生理檢查及3D 的electroanatomical mapping 系統來佐證。這個計畫若能順利的執行，不僅在臨床上帶給病人很大的幫助，同時也建立了一個影像-電生理的軟硬體平台，促成相關的研究並促進我國醫療產業的發展。<br> Abstract: About half of the patients with congestive heart failure (CHF) died from ventriculartachycardia or ventricular fibrillation (VT/VF). Defibrillation remains the method ofchoice for the treatment of VT/VF. Previous studies have demonstrated that implantablecardioverter defibrillator (ICD) could effectively reduce the mortality of patients withCHF. However, global ICD implantation could cause heavy economic burden andfurthermore, false ICD shock could result in excess mortality in patients with CHF. Thus,to noninvasively identify high risk patients with CHF is an important issue in cardiologyfield.Although there are many invasive tools to identify high risk patients, the sensitivity isfar from satisfaction. Recently, more and more studies have shown the cardiac magneticresonance image (CMRI) could not only correctly evaluate the heart function but alsocould precisely predict the prognosis of CHF patients through quantification of thesizes of myocardial core scar and gray zone. One major limitation is that this kind ofanalysis just focuses on the sizes of core scar and gray zone rather than the slowconductive channel located in the core scar, which is the main source leading to VT/VF.In the future three years, we will launch a team including clinical cardiologist,radiologist and specialists in signal analysis and mathematical modeling. We plan todevelop a noninvasive and powerful myocardial scar image-electrophysiologyevaluation tool by analyzing the myocardial scar image with novel methods andincorporating mathematic modeling of electrophysiology. Furthermore, we will validatethe tool by invasive electrophysiological study and 3D electroanatomical mapping. Wehope that through these efforts, we could not only bring great help for patients but alsopromote the progress of our medical service industry.心臟衰竭核磁共振心室頻脈心室顫動傳導通道congestive heart failuremagnetic resonance imageventricular tachycardiaventricular fibrillationconductive channel