Cardiovascular Risk, Vascular and Kidney Damage in COVID-19 Survivors

COVID-19 幸存者的心血管风险、血管和肾脏损伤

基本信息

批准号：
10364096
负责人：
JULIO ALONSO CHIRINOS MEDINA
金额：
$ 80.33万
依托单位：
UNIVERSITY OF PENNSYLVANIA
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：
2022-01-20 至 2026-12-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10364096
关键词：
Acute Admission activity Albuminuria Arrhythmia Arteries Biological Markers Blood Vessels COVID-19 COVID-19 impact COVID-19 pandemic COVID-19 survivors Cardiac Cardiovascular Diseases Cardiovascular system Cessation of life Characteristics Chronic Chronic Kidney Failure Clinical Clinical Data Cohort Studies Creatinine Electronic Health Record Endothelium Epidemiology Event Exhibits Fibrosis Frequencies Functional disorder Future Glomerular Filtration Rate Goals Gold Health Health system Heart Heart Diseases Heart failure Hospitalization Image Incidence Infection Inflammatory Injury Intervention Investigation Kidney Kidney Diseases LCN2 gene Longitudinal cohort study Measurement Measures Mechanical ventilation Mediating Microscopy Natural History Organ Outcome Outcomes Research Patients Peripheral arterial disease Phenotype Physicians Physiologic pulse Pneumonia Process Prospective cohort study Public Health Records Recovery Reference Standards Renal Replacement Therapy Renal function Risk Risk Factors SARS-CoV-2 infection Stress Stroke Structure Survivors Techniques Time Tissues Tubular formation Ultrasonography Update Vascular Diseases Vascular Endothelium Vasoconstrictor Agents acute coronary syndrome adjudicate adverse outcome arterial stiffness base brachial artery cardiovascular disorder risk cardiovascular risk factor cerebrovascular cohort community acquired pneumonia comorbidity density elastography experience high risk in vivo long term consequences of COVID-19 novel post gamma-globulins post-COVID-19 preventive intervention prospective rat KIM-1 protein renal damage severe COVID-19 sociodemographics standard measure symptomatic COVID-19 thrombotic urinary

项目摘要

PROJECT SUMMARY The coronavirus disease 2019 (COVID-19) pandemic is a public health crisis, characterized by pneumonia and multiorgan dysfunction. We previously demonstrated that community-acquired pneumonia increases the long- term risk of cardiovascular disease. There is an urgent need to investigate the incidence and mechanisms of cardiovascular disease in COVID-19 survivors. Thus, we propose a novel investigation of the intermediate and long-term cardiac, vascular, and renal consequences of COVID-19. Acutely, COVID-19 is associated with microvascular and macrovascular thrombotic events and inflammatory- and stress-related injury in the heart, kidneys, and vasculature that may put COVID-19 survivors at particularly elevated risk of chronic complications. Our study team has combined expertise in the study of post-pneumonia cardiovascular risk, vascular and kidney pathophysiology, epidemiologic outcomes research, and implementation of longitudinal prospective cohort studies. Our goal is to examine the natural history of cardiac, vascular, and kidney disease in COVID-19 survivors, and to identify risk factors for adverse longitudinal outcomes in these patients. We propose a prospective cohort study evaluating 1) cardiovascular events in a large, electronic health record-based cohort of survivors of COVID-19 in our health system compared with matched controls (“MACE cohort”) and 2) detailed vascular and renal phenotyping in a smaller cohort of COVID- 19 survivors compared with matched controls (“deep phenotyping cohort”). In the MACE cohort, we will collect detailed hospitalization, demographic, and clinical data as well as records for post-COVID-19 hospitalizations. An expert physician panel will prospectively adjudicate hospitalization records to evaluate for post-COVID-19 MACE (heart failure hospitalization, acute coronary syndrome, serious arrhythmia, stroke, peripheral artery disease, and death). In the deep phenotyping cohort, we will perform serial quantitative measurements of vascular health in large, medium-sized, and small arteries, specifically: (1) pulse wave velocity (the reference standard measure of large artery stiffness), (2) flow-mediated dilation (a measure of endothelial function), and (3) microvascular structure assessed by sublingual imaging. We will also perform serial measurements of kidney function (estimated glomerular filtration rate, albuminuria, markers of tubular injury, and exploratory ultrasound images to estimate fibrosis). We aim to assess the long-term incidence of and risk factors for MACE in COVID- 19 survivors, and to evaluate the trajectory of microvascular and macrovascular health and kidney function over time in these patients. Our mechanism-driven approach will provide critical guidance on longitudinal cardiovascular risk and vascular and kidney damage following COVID-19 infection. The results of this study will enhance our understanding of the long-term target organ effects of COVID-19 and identify risk factors that can be targeted by future interventions to ultimately reduce the risk of adverse outcomes in COVID-19 survivors.

项目概要 2019 年冠状病毒病 (COVID-19) 大流行是一场公共卫生危机，其特点是肺炎和我们之前证明，社区获得性肺炎会增加长期患病率。迫切需要研究心血管疾病的发生率和机制。因此，我们提出了一项针对中间和幸存者的心血管疾病的新研究。 COVID-19 对心脏、血管和肾脏的长期影响。急性地说，COVID-19 与微血管和大血管血栓事件以及炎症相关。以及与压力相关的心脏、肾脏和脉管系统损伤，这些损伤可能会使 COVID-19 幸存者处于特别危险的境地我们的研究团队结合了肺炎后研究的专业知识。心血管风险、血管和肾脏病理生理学、流行病学结果研究，以及我们的目标是检查心脏病的自然史， COVID-19 幸存者的血管和肾脏疾病，并确定不良纵向的危险因素我们提出一项前瞻性队列研究，评估 1) 心血管事件。与我们的卫生系统中基于电子健康记录的大型 COVID-19 幸存者群体相比匹配的对照（“MACE 队列”）和 2）在较小的 COVID-19 队列中详细的血管和肾脏表型分析 19 名幸存者与匹配的对照组进行比较（“深度表型队列”）在 MACE 队列中，我们将收集。详细的住院治疗、人口统计和临床数据以及 COVID-19 后住院治疗的记录。专家医师小组将前瞻性地裁定住院记录，以评估 COVID-19 后的情况 MACE（心力衰竭住院、急性冠状动脉综合征、严重心律失常、中风、外周动脉）在深度表型队列中，我们将进行连续的定量测量。大、中、小动脉的血管健康状况，具体来说：（1）脉搏波速度（参考值）大动脉僵硬度的标准测量），（2）血流介导的扩张（内皮功能的测量），以及 (3) 通过舌下成像评估微血管结构我们还将对肾脏进行连续测量。功能（估计肾小球滤过率、蛋白尿、肾小管损伤标志物和超声探查我们的目标是评估新冠肺炎中 MACE 的长期发病率和危险因素。 19 名幸存者，并评估微血管和大血管健康以及肾功能的轨迹我们的机制驱动方法将为这些患者的纵向治疗提供关键指导。 COVID-19 感染后的心血管风险以及血管和肾脏损伤。增强我们对 COVID-19 的长期靶器官影响的了解，并确定可能的风险因素成为未来干预措施的目标，以最终降低 COVID-19 幸存者出现不良后果的风险。