Epidemiologic Determinants of Cardiac Structure and Function in Rural Residents: RURAL ECHO

农村居民心脏结构和功能的流行病学决定因素：RURAL ECHO

• 批准号: 10852586
• 负责人: Gerald Samuel Bloomfield
• 金额: $ 57.79万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-02-21 至 2025-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10852586
• 关键词: Administrative Supplement; Adult; American; Anatomy; Ancillary Study; Appalachian Region; Area; Artificial Intelligence; Atrial Function; Biochemistry; Biological; Biological Factors; Biological Markers; Black Populations; Body mass index; Brain natriuretic peptide; Cardiac; Cardiovascular Diseases; Cardiovascular system; Clinic; Clinical; Clinical Data; Cohort Studies; Collaborations; Color; County; Data; Data Set; Demography; Dimensions; Disease; Echocardiography; Epidemiologic Factors; Epidemiology; Ethnic Population; Excess Mortality; Female; Funding; General Population; Geography; Goals; Health; Heart Abnormalities; Heart Atrium; Heart Valve Diseases; Heart failure; High Prevalence; Image; Individual; Individual Differences; Infrastructure; Intervention; Knowledge; Laboratories; Life; Link; Longitudinal Studies; Longitudinal cohort; Longitudinal cohort study; Methodology; Mission; Mississippi; Mitral Valve; Morbidity - disease rate; Morphology; Multimodal Imaging; Myocardial Infarction; N-terminal; National Heart, Lung, and Blood Institute; Obesity; Outcome; Parents; Participant; Pathology; Phenotype; Population; Population Heterogeneity; Population Study; Predisposition; Prevalence; Prognosis; Proteins; Ptosis; Public Health; Race; Reduce health disparities; Reporting; Research; Resources; Risk; Risk Assessment; Risk Factors; Rural; Rural Appalachia; Rural Population; Scientific Inquiry; Serum; Severities; Severity of illness; Somatotype; Stroke; Structure; Symptoms; Techniques; Testing; Thinness; Time; Troponin; United States National Institutes of Health; Variant; Ventricular; Vermont; Work; burden of illness; calcification; cardiovascular disorder risk; cardiovascular risk factor; circulating biomarkers; comorbidity; cost effective; health determinants; health equity; heart damage; high risk; high risk population; imaging biomarker; improved; innovation; mortality; novel; population based; population stratification; prospective; risk mitigation; risk stratification; rural America; rural area; rural dwellers; rural residence; rural underserved; screening; social factors; social health determinants; tool

ABSTRACT Rural dwelling adults in the US South suffer disproportionate cardiovascular disease (CVD) burden and mortality. The Appalachia and Mississippi Delta (AMD) regions are particularly at risk, embedded in the stroke, heart attack and heart failure (HF) mortality belts, where the determinants are multifactorial. Echocardiography is an ideal methodology to study CVD and determine high risk imaging phenotypes for incident heart failure owing to its ability to noninvasively assess cardiac structure and function simultaneously. Due to the excess of CVD in the AMD region, we therefore expect a high prevalence of abnormal cardiac structure and function among rural adults, but this has not been explicitly shown. The NHLBI-funded Risk Underlying Rural Areas Longitudinal (RURAL) cohort study, by assessing a broad array of phenotypic, biologic, and social determinants of health represents a unique, cost-effective opportunity to implement a study to fill the gaps described, reduce excess CVD burden, and achieve health equity for all Americans. The long-term goal of this proposal is to understand the burden of adverse cardiac remodeling in the absence of symptoms (i.e., Stage B HF) in the AMD region and factors contributing to it so that interventions during subclinical disease states may avert clinical HF later in life. The overall objectives of this application are to apply in-depth echocardiographic phenotyping to the entire RURAL cohort and combine these echo data with the broad array of data acquired in RURAL to identify those factors which selectively amplify or mitigate HF risk. Using the infrastructure of the parent study’s mobile examination unit (MEU) – ‘a clinic on wheels’ – we will perform echocardiography on all participants at baseline to characterize cardiac structure and function using a novel artificial-intelligence (AI) echo approach. Our central hypothesis is that there is a significant burden of Stage B HF, which is associated with exposures spanning multiple domains and which can be delineated by integrating the multimodality imaging on the MEU. We will achieve our objectives through these specific aims: (Aim 1) Use AI Echo and meticulous core lab analysis to extensively characterize cardiac structure and function in RURAL; (Aim 2) Determine associations of AI Echo findings with traditional biologic risk factors and comorbidities, with an exploratory sub-Aim to determine associations between Stage B HF and social determinants of health; and (Aim 3) To interrogate mechanisms of Stage B HF by determining relationships between echo-based imaging biomarkers, CV calcifications, adiposity and CV risk. The proposed study will provide the largest and most comprehensive echocardiographic dataset focused on rural adults that untangles the relative importance of the association between biologic and social factors on Stage B HF and incorporates advanced methodology to discover sub-phenotypes of Stage B HF based on multimodality imaging. RURAL Echo promises to yield new knowledge on rural CV health that is highly relevant to individual and US public health.

抽象的 美国南部的农村住宅成年人患有不成比例的心血管疾病（CVD）Burnen和 死亡。阿巴拉契亚和密西西比三角洲（AMD）地区尤其处于危险之中，嵌入了中风， 心脏病发作和心力衰竭（HF）死亡率带，确定词是多因素的。超声心动图 是研究CVD并确定事件心力衰竭的高风险成像表型的理想方法 由于其非侵入性评估心脏结构和功能的能力。由于过量 因此，在AMD地区的CVD，我们期望异常心脏结构和功能的患病率很高 在粗糙的成年人中，但尚未明确显示。 NHLBI资助的农村地区的风险 通过评估广泛的表型，生物学和社会的纵向（农村）队列研究 健康的决定因素代表了实施研究以填补空白的独特，具有成本效益的机会 描述，减少过多的CVD伯恩，并为所有美国人实现健康公平。这个长期目标 提案是要在没有症状的情况下了解不良心脏重塑的负担（即B期 HF）在AMD地区及其导致该地区的因素，以便在亚临床疾病状态下进行干预措施 避免临床HF后期。该应用程序的总体目标是应用深度超声心动图 表现到整个农村队列，并将这些回声数据与在 乡村确定这些因素，这些因素有选择地扩大或减轻HF风险。使用的基础架构 父母研究的移动检查单元（MEU） - “轮子上的诊所” - 我们将对所有人进行超声心动图 基线的参与者使用新颖的人工智慧（AI）来表征心脏结构和功能 回声方法。我们的中心假设是，B HF期有很大的燃烧，这是相关的 随着跨越多个域的曝光，可以通过集成多模式来划定这些域 在meu上成像。我们将通过这些特定目标来实现我们的目标：（目标1）使用AI Echo和 细致的核心实验室分析，以广泛的特征在农村中表征心脏结构和功能； （目标2） 确定AI回波发现与传统生物学风险因素和合并症的关联， 探索性的子AIM确定B HF期与健康的社会决定者之间的关联；和 （目标3）通过确定基于回声的成像之间的关系来询问B HF期的机制 生物标志物，简历钙化，肥胖和简历风险。拟议的研究将提供最大，最大的研究 综合的超声心动图数据集的重点是粗糙的成年人 生物学与社会因素之间的关联在B阶段HF上，并将高级方法纳入 基于多模态成像，发现B HF期的子表型。农村回声有望产生新的 与个人和美国公共卫生高度相关的粗糙简历健康知识。