Utility of Lung Ultrasound in Assessing Pulmonary Congestion in Heart Failure

肺部超声在评估心力衰竭肺充血中的效用

• 批准号: 9042412
• 负责人: Elke Platz
• 金额: $ 18.87万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-04-01 至 2020-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9042412
• 关键词: Accident and Emergency department; Acute; Address; Affect; Age-Years; Area; Biometry; Biostatistical Methods; Boston; Cardiology; Cardiopulmonary; Cardiovascular system; Caring; Cessation of life; Chest; Clinical; Clinical Investigator; Clinical Markers; Clinical Trials; Clinical Trials Design; Detection; Diagnosis; Diagnostic; Dyspnea; Early treatment; Echocardiography; Emergency Medicine; Epidemiologic Methods; Epidemiology; Equipment; Europe; Evaluation; Event; Extravascular Lung Water; Goals; Grant; Health; Heart failure; Hospitalization; Hospitals; Image; Imaging Device; Imaging Techniques; Inpatients; Institution; Knowledge; Laboratory Markers; Length of Stay; Lung; Measures; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Methods; Monitor; Morbidity - disease rate; North America; Outcome; Patients; Physical Examination; Population; Process; Public Health; Quality of life; Quality-of-Life Assessment; Reporting; Research; Research Design; Research Personnel; Risk; Risk Management; Speed; Stratification; Surrogate Markers; Symptoms; Testing; Time; Titrations; Training; Training Programs; Translating; Ultrasonography; Undifferentiated; Universities; Woman; Work; Writing; adverse outcome; base; cardiovascular visualization; career; career development; clinical biomarkers; design; diagnostic accuracy; heart imaging; imaging biomarker; improved; mortality; novel; point of care; prognostic significance; prognostic value; programs; prospective; response; skills; tool; treatment response

 DESCRIPTION (provided by applicant): My goal in seeking a K23 Mentored Patient-Oriented Research Career Development Award is to acquire the knowledge and skills to become an independent clinical investigator and a leader in cardiopulmonary imaging research. I have a broad background in ultrasonography, with specific expertise in lung ultrasonography and point-of-care echocardiography which are key research areas for this application. I propose to investigate the relationship of pulmonary congestion assessed by lung ultrasound (LUS) and acute decompensated heart failure (ADHF). Pulmonary congestion, often manifested by breathlessness (dyspnea), is the most common sign of ADHF and the leading cause of hospitalization in the U.S. population over 65 years of age. Patient reported dyspnea is used both clinically and in trials as a surrogate marker of pulmonary congestion, because the detection and quantification of pulmonary congestion based on current methods remains challenging. Although patient symptoms represent an important treatment goal, there is a critical need for novel quantitative markers of pulmonary congestion. Lung ultrasound (LUS) is a novel, semi-quantitative tool in the assessment of pulmonary congestion that has been identified as a useful point-of-care tool in the evaluation of undifferentiated dyspnea. "B-lines" are vertical lins on LUS which, when quantified, provide a graded measure of extra-vascular lung water. Although LUS has been used clinically as a diagnostic tool in the acute care setting, little is known about the correlates, dynamic changes and prognostic value of this method. In aim 1, we will examine the cross-sectional association of baseline B-line number with conventional clinical, biomarker, and imaging correlates of congestion, as well as short term outcomes. In aim 2, we will determine the extent to which B-line number decreases in response to therapy. In aim 3, we will examine the association of pre- discharge B-line number with long term outcomes, including heart failure related readmissions and death. These aims will be investigated at two leading academic institutions with an extensive track record of heart failure and imaging research, as well as mentorship of early career investigators. The long term goal of this proposal is to improve the assessment of pulmonary congestion in patients with heart failure and to determine the extent to which LUS as a novel imaging tool can measure sub-clinical pulmonary congestion, guide titration of therapy, and predict adverse outcomes in this population. The proposed research will be conducted in the context of a comprehensive five-year career development training program with the goal of providing me with the knowledge and skills to become an independent clinical investigator in cardiopulmonary imaging research at the interface of emergency medicine and cardiology. A team of accomplished mentors and collaborators with expertise in cardiac imaging, heart failure, quality of life assessment, epidemiology, biostatistics, and clinical trials will guide me in my transition to scientific independence.

 描述（由应用程序提供）：我寻求K23指导的以患者为导向的研究职业发展奖的目标是获得知识和技能，以成为独立的临床研究者和心肺成像研究的领导者。我在超声检查方面具有广泛的背景，具有肺超声检查和护理超声心动图方面的特定专业知识，这是该应用程序的关键研究领域。我建议研究通过肺超声（LUS）和急性代偿性心力衰竭（ADHF）评估的肺拥堵关系。肺部充血经常以呼吸困难（呼吸困难）表现出来，是ADHF的最常见征兆，也是65岁以上美国人口住院的主要原因。患者报告说，呼吸困难在临床和试验中都被用作肺部充血的替代标志，因为基于当前方法的肺部充血的检测和定量仍然挑战。尽管患者症状代表了一个重要的治疗目标，但迫切需要新的肺部充血定量标记。肺超声（LUS）是评估肺部充血的一种新型半定量工具，已被确定为评估未分化呼吸困难的有用的护理工具。 “ B线”是LU上的垂直LINS，在量化时，尽管LUS在急性护理环境中已被用作诊断工具，但对此方法的相关性，动态变化和预后价值知之甚少。在AIM 1中，我们将研究基线B线数与传统临床，生物标志物和交通拥堵的成像相关性以及短期结果的横截面关联。在AIM 2中，我们将确定响应治疗的B线数量减少的程度。在AIM 3中，我们将研究前放电B线数与长期结果的关联，包括与心力衰竭相关的再入院和死亡。这些目标将在两个领先的学术机构进行调查，并具有心力衰竭和成像研究的广泛记录，以及早期职业研究人员的指导。该提案的长期目标是改善心力衰竭患者的肺部充血评估，并确定LU作为新型成像工具的程度可以测量临床肺部充血，指导治疗的滴定以及预测该人群的不良结果。拟议的研究将在一项全面的五年职业发展培训计划的背景下进行，目的是为我提供知识和技能，以成为在出现医学和心脏病学界面上的心肺成像研究中的独立临床研究者。一支成立的导师和合作者团队在心脏成像，心力衰竭，生活质量评估，流行病学，生物统计学和临床​​试验方面具有专业知识，将指导我过渡到科学独立性。