Modifiable Determinants of Ventricular Arrythmias

室性心律失常的可改变决定因素

• 批准号: 7137617
• 负责人: CHRISTINE M ALBERT
• 金额: $ 12.6万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-08-01 至 2008-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7137617
• 关键词: ACE inhibitors; alcoholic beverage consumption; angers; antihypercholesterolemic agent; anxiety; behavioral /social science research tag; beta antiadrenergic agent; cardiovascular disorder epidemiology; cardiovascular disorder risk; clinical research; exercise; human data; implantable defibrillators; lifestyle; mathematical model; medical implant science; smoking; social psychology; tachycardia; ventricular fibrillation

DESCRIPTION (provided by applicant): Since ventricular tachycardia (VT) and/or ventricular fibrillation (VF) underlie approximately 80% of the 400,000 SCDs that occur in the United states annually, the identification of risk factors for VT/VF is of public health importance. We are submitting this application in response to PA-03-015, which uses the R21 mechanism. This program requires the utilization of existing human data, does not require preliminary results, and limits the Research Plan to only 10 pages. In this application, we propose to utilize existing data assembled during the Triggers of Ventricular Arrhythmias (TOVA) study to identify predictors of ventricular arrhythmias in a population known to be at high risk. TOVA is a multi-center prospective cohort study that enrolled 1188 ICD patients at 31 centers in the United States and was designed to identify triggers of VT/VF among susceptible patients. The extensive information collected on clinical characteristics, lifestyle habits, psychosocial factors, and medications along with the collection and validation of electrograms from 500 instances of ICD firings over the course of the study provides a unique opportunity to examine the impact of lifestyle factors and medications on subsequent shocks for life-threatening ventricular arrhythmias. Specific hypotheses that will be examined in this population include the impact of psychosocial factors such as anger and anxiety; lifestyle factors such as smoking, alcohol, and physical activity; and non-traditional antiarrhythmic medications such as statins and angiotensin converting enzyme inhibitors on the risk of VT/VF. Multivariable Cox proportional hazards models will be used to evaluate associations between exposures and time to first ICD discharge for a confirmed episode of VT/VF, and Anderson-Gill proportional hazards models will be used to incorporate recurrent ICD discharges. By identifying risk factors specific for VT/VF in this high risk population, new understanding regarding the pathophysiology of ventricular arrhythmias may be gained, which may aid in the development of new preventive modalities for ventricular arrhythmias and SCO in the general population as well as in high risk patients. As a secondary goal, the identification of potentially modifiable lifestyle habits and medications that may influence risk of painful ICD shocks may significantly impact the clinical management and the subsequent quality of life of ICD patients.

描述（由申请人提供）：由于美国每年发生的 400,000 例 SCD 中约 80% 是由室性心动过速 (VT) 和/或室颤 (VF) 引起的，因此识别 VT/VF 的危险因素关系到公共卫生问题重要性。我们提交此申请是为了响应 PA-03-015，该申请使用 R21 机制。该计划需要利用现有的人类数据，不需要初步结果，并将研究计划限制为仅 10 页。在此应用中，我们建议利用室性心律失常触发因素 (TOVA) 研究期间收集的现有数据来确定已知高危人群中室性心律失常的预测因素。 TOVA 是一项多中心前瞻性队列研究，入组了美国 31 个中心的 1188 名 ICD 患者，旨在确定易感患者中 VT/VF 的触发因素。研究过程中收集的有关临床特征、生活习惯、心理社会因素和药物的广泛信息，以及从 500 个 ICD 放电实例中收集和验证的电图，为检查生活方式因素和药物对患者的影响提供了独特的机会。随后对危及生命的室性心律失常进行电击。将在该人群中检验的具体假设包括愤怒和焦虑等社会心理因素的影响；生活方式因素，例如吸烟、饮酒和体力活动；以及非传统抗心律失常药物（如他汀类药物和血管紧张素转换酶抑制剂）对 VT/VF 风险的影响。多变量 Cox 比例风险模型将用于评估已确认的 VT/VF 发作的暴露与首次 ICD 出院时间之间的关联，Anderson-Gill 比例风险模型将用于纳入反复 ICD 出院。通过识别高危人群中 VT/VF 特有的危险因素，可以获得对室性心律失常病理生理学的新认识，这可能有助于开发针对普通人群以及 SCO 的室性心律失常和 SCO 的新预防方式。高危患者。作为次要目标，确定可能影响 ICD 电击疼痛风险的潜在可改变的生活方式和药物可能会显着影响 ICD 患者的临床管理和随后的生活质量。