DECIPHER

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• 批准号: 7691331
• 负责人: CHELSEA S KIDWELL
• 金额: $ 57.97万
• 依托单位: GEORGETOWN UNIVERSITY
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/7691331
• 关键词: Acute; Animals; Apolipoprotein E; Blood Vessels; Blood specimen; Cerebral Amyloid Angiopathy; Cerebral hemisphere hemorrhage; Cerebrum; Chronic; Cohort Studies; DNA; DNA analysis; Data; Development; Digit structure; Disease Progression; Enrollment; Ethnic Origin; Etiology; Event; Future; General Population; Genetic; Goals; Hemorrhage; Hypertension; Impaired cognition; Incidence; Intervention Trial; Ischemic Stroke; Lesion; Leukoaraiosis; Magnetic Resonance Imaging; Measures; Mutation; Names; Natural History; Neurologic; Neurological outcome; Numbers; Patients; Population; Prevalence; Prophylactic treatment; Race; Rate; Recurrence; Risk; Risk Factors; Score; Secondary Prevention; Sickle Cell Anemia; Testing; Time; Underserved Population; cerebrovascular; day; design; disabling disease; follow-up; functional outcomes; genetic risk factor; insight; mortality; notch protein; prognostic; prospective; racial/ethnic difference

The overall goal of DECIPHER is to investigate whether racial/ethnic differences exist in the underlying risk factors for chronic cerebral microbleeds in patients with primary ICH and to determine the prognostic impact of microbleeds in a predominantly underserved ICH population. Intracerebral hemorrhage (ICH) is a devastating and disabling disease with 30 day mortality rates estimated at 35-52%. Primary ICH is 2-3 times more common in many underserved populations, including blacks. Hypertension and cerebral amyloid angiopathy have been identified as common risk factors for primary ICH in the general population. Microbleeds, clinically silent small, chronic hemorrhages identified on gradient echo (GRE) MRI, are present in approximately 70% of patients with primary ICH and are hypothesized to be a marker of a hemorrhageprone vasculopathy. In patients with cerebral amyloid angiopathy, the number of microbleeds has significant prognostic value, predicting future risk of ICH, poor long-term neurologic outcome, and cognitive decline. Our recent pilot data suggest that black patients presenting with ICH have a significantly greater number of chronic microbleeds compared to whites. However, the underlying etiology and significance of this finding are unknown. The 4 specific aims of this longitudinal, MR imaging cohort study are: 1) To quantify by race/ethnicity the prevalence, lesion burden and risk factors of chronic cerebral microbleeds in patients with primary ICH; 2) To quantify the prognostic impact of initial microbleed burden by race/ethnicity; 3) To quantify the long-term rate of development of new microbleeds by race/ethnicity and to correlate this rate with neurologic and functional outcome; and 4) To perform a genetic substudy to explore genetic risk factors for ICH and microbleeds in this underserved population. A total of 189 patients with primary ICH will be enrolled and followed for up to 4 years. Repeat MRIs including GRE sequences will be performed at years 1 and 3 and evaluated for progression of disease (new microbleeds, recurrent ICH, ischemic stroke, and leukoaraiosis). Additional measures to be evaluated will include demographic information, presence and control of vascular risk factors including hypertension, apolipoprotein E status, and functional outcome. This project will not only provide insight into the significance of microbleeds in underserved ICH populations, but will also provide pilot data for design of future intervention trials of secondary prevention measures.

破译的总体目标是调查潜在风险中是否存在种族/种族差异 原发性ICH患者的慢性脑微孔体的因素并确定预后影响 在主要服务不足的ICH人群中的微孔物。脑内出血（ICH）是 30天死亡率估计为35-52％，毁灭性和致残性疾病。主要ICH是2-3次 在包括黑人在内的许多服务不足的人群中更常见。高血压和脑淀粉样蛋白 在普通人群中，血管病已被确定为主要ICH的常见危险因素。 在梯度回波（GRE）MRI上鉴定出的临床沉默的小型，慢性出血的微粒 在大约70％的初级ICH患者中，假设是出血的标志 血管病。在脑淀粉样血管病的患者中 预后价值，预测ICH的未来风险，差的长期神经系统结果和认知能力下降。我们的 最近的试点数据表明，出现ICH的黑人患者的数量明显更大 与白人相比，慢性微粒。但是，这一发现的基本病因和意义 是未知的。这项纵向，MR成像队列研究的4个具体目标是：1）量化 种族/种族患者患者的患病率，病变负担和危险因素 主要ICH； 2）量化种族/种族最初微型负担的预后影响； 3）到 量化种族/种族的新微型销售的长期发展速度 具有神经和功能性结果； 4）执行遗传性探索遗传危险因素 对于这个服务不足的人群中的ICH和微粒。共有189例主要ICH患者将是 注册并紧随其后的4年。重复MRI（包括GRE序列）将在第1年进行 和3并评估疾病进展 白细胞病）。要评估的其他措施将包括人口统计信息，存在和 控制血管危险因素，包括高血压，载脂蛋白E状态和功能结果。这 项目不仅可以洞悉微粒在服务不足的ICH人群中的意义，而且还可以提供 还将提供试点数据，以设计未来的二级预防措施的干预试验。