Cardioembolism as a Mechanism of Central Retinal Artery Occlusion

心源性栓塞作为视网膜中央动脉闭塞的机制

基本信息

批准号：
10773701
负责人：
Brian Mac Grory
金额：
$ 5.32万
依托单位：
DUKE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-01 至 2024-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10773701
关键词：
Academic Medical Centers Acute Address Administrative Supplement Affect Age Anticoagulation Applied Research Area Atrial Fibrillation Attenuated Award Awareness Back Biological Markers Biometry Blood Vessels Blood coagulation Brain imaging Cardiac Cardiac Electrophysiologic Techniques Cardiology Carotid Atherosclerotic Disease Carotid Stenosis Central Retinal Artery Occlusion Cerebrovascular Disorders Cerebrum Clinic Clinical Investigator Clinical Research Coagulation Process Collaborations Comparative Effectiveness Research Cross-Sectional Studies Data Data Science Data Set Databases Death Rate Development Diagnosis Diagnostic Diameter Disease Electrocardiogram Embolism Etiology Eye Failure Fright Functional disorder Future Goals Heart Heart Atrium Heart Diseases Incidence Institution Internal Carotid Artery Stenosis Investigation Ipsilateral Ischemic Stroke K-Series Research Career Programs Left Life Link Medicare Medicine Mentored Patient-Oriented Research Career Development Award Mentors Mentorship Methodology Monitor Neurology Observation in research Observational Study Ophthalmology Output Parents Paternity Leave Pathogenesis Pathology Pathway interactions Patients Persons Pharmacy facility Physicians Physiological Play Population Prevention strategy Principal Investigator Publications Recurrence Research Research Design Research Personnel Retina Risk Risk Factors Role Sampling Scientist Secondary Prevention Sentinel Serum Societies Stenosis Stroke Structure Testing Therapeutic Embolization Thrombus Time Training Ultrasonography United States National Institutes of Health Ventricular Ventricular Dysfunction Visual Walking beneficiary cardiovascular risk factor career career development cohort comorbidity disability evidence base heart rhythm indexing insight multidisciplinary novel patient oriented patient subsets population based prevent prospective risk mitigation sex skills

项目摘要

ABSTRACT This is an application for an Administrative Supplement to Promote Research Continuity and Retention of NIH Mentored Career Development (K) Award recipients. The purpose is to provide the principal investigator, Dr. Brian Mac Grory, with the support necessary to maintain his research output during a period of paternity leave. Dr. Mac Grory is a vascular neurology investigator pursuing patient-oriented clinical research focused on the identification of novel populations with underexplored cerebrovascular disorders requiring personalized secondary prevention strategies. Based on compelling preliminary data and recent publications, the central hypothesis of this proposal is that central retinal artery occlusion (CRAO) – a form of ischemic stroke affecting the retina – may be an indicator of underlying cardiac disease and a sentinel of future, potentially lethal, cardioembolic stroke. CRAO is formally recognized as a form of ischemic stroke but there is an incomplete understanding of its mechanistic underpinnings, with most research to-date focused on its association with carotid artery stenosis. The parent K23 award proposes to generate key preliminary data linking CRAO with cardioembolic substrates and set the stage for a future, multi-center, observational study that will definitively test this hypothesis. Dr. Mac Grory will leverage a very large population-based dataset (the Medicare 5% Sample) as well as both retrospective and prospective institutional cohorts. Specific Aims 1A & 1B will determine the association of each of atrial fibrillation and left ventricular failure with the development of CRAO and comprise the focus of the current application for an Administrative Supplement. Specific Aims 2A & 2B will determine the association of cardiac, serum and ultrasonographic biomarkers of embolic risk with CRAO and their interplay with carotid artery stenosis. As part of this proposal, Dr. Mac Grory will undertake a linked, didactic training plan with the goal of developing as an independent investigator through acquisition of the following key skills: 1) Biostatistics in observational research including advanced causal inference methodology, 2) Data science applied to administrative claims databases, 3) Prospective, observational study design, and 4) Vascular biomarker interpretation. Advanced training in these areas will permit Dr. Mac Grory to realize his long-term career goal of becoming an independent clinical investigator who leverages interdisciplinary expertise to provide insights in to the management of understudied cerebrovascular disorders. In pursuit of this goal, Dr. Mac Grory has assembled a mentoring team with distinct though complementary skillsets in stroke medicine, comparative effectiveness research, causal inference methodology, cardiac electrophysiology, and neuro-ophthalmology. With the preliminary data and training obtained from the proposed research, Dr. Mac Grory will be uniquely equipped to execute future, larger-scale studies uncovering novel populations in whom evidence-based, potentially life-saving secondary prevention strategies may be deployed. The scientific goals and approach remain unchanged from the original proposal.

抽象的这是对行政补充的申请，以促进研究连续性和保留NIH 指导的职业发展（K）奖获得者。目的是提供主要研究人员，博士。布莱恩·麦克·格里（Brian Mac Grory），在陪产假期间保持其研究成果所需的支持。 Mac Grory博士是一名血管神经病学研究者，追求以患者为导向的临床研究，重点是识别需要个性化的脑血管疾病的新型人群二级预防策略。基于引人入胜的初步数据和最新出版物，中央该提议的假设是中央残留动脉闭塞（CRAO） - 一种缺血性中风形式视网膜 - 可能是潜在的心脏病和未来前哨的指标，可能是致命的，心血管中风。 CRAO正式被公认为是缺血性中风的一种形式，但有一个不完整的理解其机械基础，大多数研究都集中在其与颈动脉狭窄。家长K23奖励提案生成关键的初步数据，将CRAO链接到心脏符号底物并为未来的多中心，观察性研究奠定了基础检验此假设。 Mac Grory博士将利用一个非常大的基于人群的数据集（Medicare 5％样本）以及回顾性和前瞻性机构人群。具体目标1A和1B将确定每个房颤和左心室衰竭与CRAO的发展的关联并构成当前的行政补充申请的重点。特定目标2A和2B 将确定栓塞风险与CRAO的心脏，血清和超声生物标志物的关联以及它们与颈动脉狭窄的相互作用。作为该提案的一部分，Mac Grory博士将进行链接，教学培训计划的目的是通过收购作为独立研究者发展遵循关键技能：1）观察研究中的生物统计学包括高级因果推理方法论，2）数据科学应用于行政索赔数据库，3）前瞻性，观察性研究设计和4）血管生物标志物解释。在这些领域的高级培训将使Mac Grory博士能够意识到他的长期职业目标是成为一个独立的临床研究者跨学科的专业知识可以为理解的脑血管疾病的管理提供见解。为了实现这一目标，麦克·格里（Mac Grory）博士召集了一支精神上的团队中风医学中的技能集，比较有效性研究，因果推理方法，心脏电生理学和神经浏览性。从初步数据和培训中获得的拟议的研究，麦克格里博士将与执行未来的大规模研究完全等同于新的人群可能是基于证据的，潜在的挽救生命的二级预防策略部署。科学目标和方法与原始提案保持不变。