Cardiotoxicity in Total Joint Arthroplasty

全关节置换术中的心脏毒性

• 批准号: 9980492
• 负责人: Hilal Maradit Kremers
• 金额: $ 70.09万
• 依托单位: MAYO CLINIC ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-19 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9980492
• 关键词: 3-Dimensional; Address; Age; American; Autopsy; Cardiac; Cardiac Output; Cardiomyopathies; Cardiotoxicity; Case Study; Ceramics; Characteristics; Chromium; Chronic; Clinic; Clinical; Cobalt; Communities; Corrosion; Data; Databases; EFRAC; Echocardiography; Epidemic; Epidemiology; Exposure to; Fibrinogen; Funding; Future; Goals; Heart Atrium; Heart Valves; Heart failure; Hip Joint; Hip Prosthesis; Immune response; Implant; Incidence; Infrastructure; Ions; Knee Prosthesis; Knee joint; Knowledge; Left; Long-Term Effects; Lung; Measures; Medical Record Linkage; Metals; Monitor; Myocardial tissue; Obesity; Operative Surgical Procedures; Patient risk; Patients; Policies; Polyethylenes; Population Study; Prevalence; Publishing; Quality of life; Registries; Replacement Arthroplasty; Research; Risk; Role; Safety; Series; Serum; Structure; Surface; Synovial Fluid; System; Time; Titanium; United States; United States National Institutes of Health; Ventricular; cardiovascular risk factor; clinical risk; cohort; data registry; data resource; experience; heart function; high risk; improved mobility; pericardial sac; population based; pressure; procedure safety; prospective; recruit; sex

ABSTRACT Total joint arthroplasty (TJA) is the fastest growing elective surgery in the nation. Over 7 million Americans are currently living artificial hip or knee joints and this is expected to reach epidemic proportions as a result of growing demand for improved mobility and quality of life. Although TJA is a relatively safe procedure, there is growing concern about the long-term systemic effects of chronic exposure to TJA implants. Indeed, in a growing number of published case reports, TJA patients present with cardiotoxicity and heart failure several years after surgery. Yet, the mechanisms and the magnitude of the risk are unknown. Large scale, population- based studies are needed to assess the potential contribution of chronic exposure to TJA implant debris and subtypes (cobalt/chromium, polyethylene) to the risk of cardiotoxicity and heart failure. We propose to leverage unique population-based data resources and the Mayo Clinic TJA registry to investigate cardiotoxicity in TJA patients. Using 5-decades of historical data from the REP, we will compare the risk of heart failure in population-based cohorts of TJA patients and matched non-TJA subjects adjusting for well- known confounders. We will further examine the risk according to implant types. We will retrieve historical echocardiographic data to compare cardiac structure and function measures in TJA patients and controls. Finally, we will correlate metal ion levels with cross-sectional and longitudinal cardiac structure and function measures in TJA patients. Successful completion of the proposed series of studies will be a key step towards understanding whether chronic exposure to TJA implants has adverse cardiac effects. Our unique data resources offer a rare opportunity to efficiently address this unknown risk. Potential downstream effects are significant including monitoring of high risk TJA implants and patients who are most likely to suffer from systemic cardiac effects.

抽象的 全关节置换术（TJA）是全美增长最快的择期手术。超过700万 美国人目前正在使用人工髋关节或膝关节，这预计将成为流行病 由于对改善流动性和生活质量的需求不断增长。虽然 TJA 是一种相对安全的手术，人们越来越担心其长期系统性影响 长期接触 TJA 植入物的影响。事实上，在越来越多的公开案例中 据报道，TJA 患者在术后几年出现心脏毒性和心力衰竭。 然而，风险的机制和严重程度尚不清楚。规模大、人口多—— 需要基础研究来评估长期接触 TJA 的潜在影响 植入物碎片和亚型（钴/铬、聚乙烯）存在心脏毒性和 心脏衰竭。我们建议利用独特的基于人口的数据资源和梅奥 临床 TJA 登记处调查 TJA 患者的心脏毒性。 使用 REP 的 5 个十年的历史数据，我们将比较不同国家的心力衰竭风险 基于人群的 TJA 患者队列和匹配的非 TJA 受试者调整良好 已知的混杂因素。我们将根据种植体类型进一步检查风险。我们将 检索历史超声心动图数据以比较心脏结构和功能测量 TJA 患者和对照组。最后，我们将金属离子水平与横截面和 TJA 患者的纵向心脏结构和功能测量。 成功完成拟议的系列研究将是迈向这一目标的关键一步 了解长期接触 TJA 植入物是否会对心脏产生不良影响。我们的 独特的数据资源为有效解决这一未知风险提供了难得的机会。潜在的 下游影响显着，包括监测高风险 TJA 植入物和患者 谁最有可能遭受全身性心脏影响。