Ventricular remodeling and heart failure after myocardial infarction: a community

心肌梗死后心室重构和心力衰竭：社区

• 批准号: 8977419
• 负责人: MAURICE ENRIQUEZ-SARANO
• 金额: $ 74.25万
• 依托单位: MAYO CLINIC ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-01-15 至 2017-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8977419
• 关键词: 3-Dimensional; Acute; Address; Admission activity; Affect; Biological; Biological Markers; Cardiac; Cardiovascular Diseases; Characteristics; Cicatrix; Clinical; Clinical Trials; Communities; Complex; Coronary; Coronary heart disease; Data; Development; Diagnosis; Dilatation - action; EFRAC; Educational workshop; Epidemiology; Event; Excess Mortality; Extracellular Matrix; Face; Frequencies; Future; Goals; Health; Heart failure; Heterogeneity; Hospitalization; Image; Imaging Techniques; Incidence; Inflammation; Injury; Intervention; Knowledge; Left Ventricular Remodeling; Left atrial structure; Left ventricular structure; Measurement; Measures; Methods; Mitral Valve; Mitral Valve Insufficiency; Morbidity - disease rate; Muscle Cells; Myocardial; Myocardial Infarction; Myocardial dysfunction; National Heart, Lung, and Blood Institute; Pathway interactions; Patients; Pattern; Persons; Population; Prevention; Process; Publishing; Recommendation; Recovery; Recruitment Activity; Research; Risk; Role; Sampling; Severities; Shapes; Staging; Stress; Testing; Three-Dimensional Echocardiography; Time; Two-Dimensional Echocardiography; Ventricular; Ventricular Dysfunction; Ventricular Remodeling; clinical application; clinical biomarkers; clinical practice; clinical risk; clinically relevant; cohort; fibrogenesis; high risk; imaging biomarker; improved; indexing; innovation; insight; meetings; men; mortality; novel; novel marker; population based; prevent; prospective; study population; tool; two-dimensional; working group

DESCRIPTION (provided by applicant): Over the past 2 decades, major changes in the epidemiology of myocardial infarction (MI) have occurred. Progress in its acute treatment improved short term survival, but heart failure (HF) remains frequent after MI and leads to excess mortality. Hence, the acute treatment of MI aimed at restoring vessel patency is not sufficient to prevent HF, underscoring the importance of understanding the contemporary mechanisms leading to its development. The transition from the initial myocardial injury to ventricular dysfunction and HF is termed left ventricular remodeling and is characterized by progressive ventricular enlargement, alteration of systolic and diastolic function and occurrence of mitral regurgitation (MR). Remodeling is a dynamic entity, defined as a change over time, diagnosed at a stage where deleterious changes cannot be reversed. Hence, it must be predicted and prevented. Knowledge on cardiac remodeling after MI is incomplete, which hinders its prevention. Firstly, the exact incidence of remodeling remains to be defined as data pertain mostly to clinical trials, of uncertain clinical relevance. Secondly, the mechanisms of ventricular remodeling after MI remain to be defined with the goal of identifying novel predictors that could define targets for prevention and treatment. Thirdly, most imaging data on remodeling do not reflect state of the art methods or contemporary cohorts. Thus, addressing the frequency and mechanisms of remodeling after MI is needed to define strategies to prevent HF and requires relying on clinically relevant populations evaluated by rigorous imaging techniques integrated with measurements of novel biomarkers. Our 3 specific aims will help elucidate, within a prospective community cohort, the frequency and mechanisms of ventricular remodeling and the responsibilities of these mechanisms in the genesis of post MI HF. Aim 1 will measure the frequency and patterns of left ventricular remodeling after incident MI in a community-based population. Remodeling will be evaluated by two- and three-dimensional echocardiography and speckle tracking and defined as changes in systolic or diastolic function and MR. Aim 2 will assess the determinants of remodeling, including clinical characteristics and novel biomarkers. Aim 3 will test the value of the predictors of remodeling identified in Aim 2 to predict HF after MI. In Aims 1 and 2, we will recruit 420 patients to obtain serial two-dimensional and three-dimensional echocardiographic studies. Aim 3 will extend these findings to the entire population-based MI incidence cohort. Our proposed application comprises several key innovative aspects. Our ongoing surveillance of coronary disease will provide a strong recruitment platform and a robust backdrop to optimize the clinical relevance of our data. Rigorous imaging approaches will provide unique insights into the remodeling process. We will integrate imaging and biomarker data to identify predictors of remodeling that can be measured at index MI to enable risk prediction of HF in contemporary MI populations.

描述（由申请人提供）：在过去的20年中，发生了心肌梗塞（MI）流行病学的重大变化。急性治疗的进展提高了短期存活率，但是MI后心力衰竭（HF）仍然频繁，导致过量死亡。因此，旨在恢复血管通畅的MI的急性治疗不足以防止HF，强调理解导致其发展的当代机制的重要性。从最初的心肌损伤到心室功能障碍和HF的过渡称为左心室重塑，其特征是进行性心室肿大，收缩压和舒张功能的改变以及二尖瓣反流的发生（MR）。重塑是一个动态实体，定义为随着时间的变化，在无法逆转有害变化的阶段被诊断出来。因此，必须预测和预防。 MI后心脏重塑的知识不完整，这阻碍了预防。首先，重塑的确切发生率仍有待定义为主要与临床试验有关的数据，这是不确定的临床相关性。其次，MI后心室重塑的机制仍有待定义，目的是确定可以定义预防和治疗靶标的新型预测因子。第三，大多数有关重塑的成像数据不能反映最先进的方法或当代人群的状态。因此，需要在MI后解决重塑的频率和机制，以定义防止HF的策略，并需要依靠通过与新生物标志物测量的严格成像技术评估的临床相关种群。我们的3个具体目标将有助于在前瞻性社区队列中阐明心室重塑的频率和机制以及在MI HF的起源中这些机制的责任。 AIM 1将测量在基于社区的人群中发生MI后左心室重塑的频率和模式。重塑将通过二维超声心动图和斑点跟踪评估，并定义为收缩期或舒张功能的变化以及MR。 AIM 2将评估重塑的决定因素，包括临床特征和新型生物标志物。 AIM 3将测试AIM 2中确定的重塑预测因子的值，以预测MI后HF。在目标1和2中，我们将招募420名患者获得串行二维 和三维超声心动图研究。 AIM 3将把这些发现扩展到整个基于人群的MI发病率队列。我们提出的应用程序包括几个关键的创新方面。我们对冠状动脉疾病的持续监视将提供强大的招聘平台和强大的背景，以优化我们数据的临床相关性。严格的成像方法将为重塑过程提供独特的见解。我们将集成成像和生物标志物数据，以识别可以在INDEX MI上测量的重塑预测指标，以实现当代MI种群中HF的风险预测。