CARDIAC PERFORMANCE BY QUANTITATIVE ECHOCARDIOGRAPHY

通过定量超声心动图检查心脏功能

• 批准号: 6901808
• 负责人: JOHN GORCSAN
• 金额: $ 11.96万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2001
• 资助国家: 美国
• 起止时间: 2001-07-01 至 2006-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6901808
• 关键词: adenosine; circulatory assist; coronary bypass; dobutamine; echocardiography; heart contraction; heart disorder chemotherapy; heart disorder diagnosis; heart failure; heart function; heart ventricle; human subject; longitudinal human study; outcomes research; patient care management; patient oriented research; postoperative state; statistics /biometry; tumor necrosis factor alpha

DESCRIPTION (Applicant?s Abstract) The candidate is a 42-year-old tenured Associate Professor who is in his 11th year after fellowship training. He is an established independent investigator who is completely committed to a life-long career in research and the mentoring of trainees. His outstanding institutional environment is supportive of high quality collaboration and ongoing research. This Midcareer Investigator Award in Patient-Oriented Research proposal will enable the expansion of two principal areas of hypotheses-driven human research: 1) Effects of cytokines on left ventricular (LV) performance in patients undergoing cardiac surgery and 2) Assessment of contractile reserve to predict prognosis in heart failure patients. The American Heart Association has recently awarded a National Grant-In-Aid entitled "Effects of Inflammatory Mediators on Left Ventricular Performance Following Cardiac Surgery" to the applicant as PI. This 3-year grant will support the infrastructure that is a requirement of this K24 application. A specific aim is to test the hypothesis that inflammatory mediators play an important role in cardiac depression following coronary bypass surgery. In particular, expression of the cytokine TNF- alpha will be studied both systemically and locally in coronary sinus samples. Seventy-two patients will be studied before and after bypass using transesophageal echo automated border detection and high fidelity pressure catheters to quantify LV performance in a predominant load-independent manner using pressure-volume relations. The anti-cytokine role of adenosine will be explored by randomizing patients to receive either routine cardioplegeia or an adenosine cardiopledgia. This K24 award will allow the applicant to expand this research work and mentor research fellows by directly involving them in this and related projects. The second arm of this proposal will test the hypothesis that contractile reserve is an important prognostic determinant in patients with severe heart failure. Dobutamine echocardiography will noninvasively assess the functionality of the myocardial beta-adrenergic receptor complex in 100 heart failure patients with ejection fraction less than 35%. Quantitative automated border detection and tissue Doppler will be used. Contractile reserve will be tested as a marker for patient?s prognosis using: preload-adjusted maximal power, tissue Doppler measures of longitudinal shortening velocity, and right ventricular fractional area change. The inability to augment ventricular contractility in response to dobutamine will be tested as a marker predictive of cardiac morbidity or mortality within one year. Patients will be followed for adverse events defined as requirements for hospitalization for heart failure, continuous intravenous inotropic or mechanical circulatory support. This information has promise to dramatically impact on the clinical management of these patients, including priority status for transplantation or mechanical circulatory assist device implantation. These ongoing studies provide ample opportunities for mentoring of fellows in patient-oriented research.

DESCRIPTION (Applicant?s Abstract) The candidate is a 42-year-old tenured Associate Professor who is in his 11th year after fellowship training. He is an established independent investigator who is completely committed to a life-long career in research and the mentoring of trainees. His outstanding institutional environment is 支持高质量的合作和正在进行的研究。 This Midcareer Investigator Award in Patient-Oriented Research proposal will enable the expansion of two principal areas of hypotheses-driven human research: 1) Effects of cytokines on left ventricular (LV) performance in patients undergoing cardiac surgery and 2) Assessment of contractile reserve to predict prognosis in heart failure patients.美国心脏协会有 最近授予了一项题为“炎症的影响的国家赠款 心脏手术后左心室表现的介体” 申请人为pi。这项为期3年的赠款将支持一个基础设施 此K24应用程序的要求。一个具体的目的是检验假设 炎症介质在心脏抑郁症中起着重要作用 冠状动脉搭桥手术。特别是，细胞因子的表达 TNF- alpha将在冠状窦有系统地和本地研究 样品。使用七十二名患者将在使用之前和之后使用 经食管回声自动化边界检测和高保真压力 以主要负载方式量化LV性能的导管 使用压力卷关系。腺苷的抗周围因子作用将是 通过随机将患者随机接受常规心脏地核或 腺苷心脏。该K24奖将允许申请人扩展 这项研究工作和指导研究研究员直接参与 这个及相关项目。该提案的第二组将测试 假设收缩储备是重要的预后决定因素 严重心力衰竭的患者。多巴丁胺超声心动图会 非侵入性评估心肌β-肾上腺素能的功能 100例心力衰竭患者的受体复合物较少 超过35％。定量自动边界检测和组织多普勒将是 用过的。收缩储备将作为患者预后的标记进行测试 使用：预加载的最大功率，组织多普勒的纵向测量 缩短速度和右心室部分区域变化。这 无法增强多巴丁胺的心室收缩力 被视为预测心脏发病率或死亡率的标志物 年。将遵循患者的不良事件定义为要求 用于心力衰竭的住院，连续静脉肌力或 机械循环支持。这些信息有望急剧 对这些患者的临床管理的影响，包括优先状态 用于移植或机械循环辅助装置植入。 这些正在进行的研究为指导研究员提供了足够的机会 面向患者的研究。