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

基本信息

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
项目类别：
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

项目摘要

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.

抽象的生活在美国南部的农村成年人承受着不成比例的心血管疾病 (CVD) 负担阿巴拉契亚和密西西比三角洲 (AMD) 地区的死亡率尤其高，其中包括中风、心脏病发作和心力衰竭（HF）死亡率带，其决定因素是多因素的。是研究 CVD 和确定心力衰竭高风险影像表型的理想方法由于其能够同时无创地评估心脏结构和功能。 AMD 区域的 CVD，因此我们预计心脏结构和功能异常的患病率很高农村成年人中的风险，但 NHLBI 资助的农村地区潜在风险尚未明确显示。纵向（农村）队列研究，通过评估广泛的表型、生物学和社会学健康决定因素是开展研究以填补空白的独特且具有成本效益的机会描述的，减少过多的CVD负担，实现所有美国人的健康公平是这一长期目标。建议是了解在没有症状的情况下不良心脏重塑的负担（即 B 期） AMD 区域的 HF）及其影响因素，以便在亚临床疾病状态期间进行干预可能避免晚年出现临床心力衰竭。本应用的总体目标是应用深入的超声心动图。对整个 RURAL 队列进行表型分析，并将这些回波数据与在 RURAL 使用基础设施来确定选择性放大或减轻 HF 风险的因素。家长研究的移动检查单元（MEU）——“车轮上的诊所”——我们将对所有患者进行超声心动图检查参与者在基线时使用新型人工智能 (AI) 来表征心脏结构和功能我们的中心假设是 B 期 HF 存在显着的负担，这是相关的。暴露跨越多个领域，可以通过集成多模态来描述我们将通过以下具体目标实现我们的目标：（目标 1）使用 AI Echo 和细致的核心实验室分析，主要表征 RURAL 的心脏结构和功能（目标 2）确定 AI Echo 结果与传统生物风险因素和合并症的关联探索性子目标是确定 B 期心力衰竭与健康社会决定因素之间的关联；以及（目标 3）通过确定基于回波的成像之间的关系来询问 B 期 HF 的机制拟议的研究将提供最大和最多的生物标志物、心血管钙化、肥胖和心血管风险。全面的超声心动图数据集侧重于农村成年人，阐明了农村成年人的相对重要性 B 期 HF 的生物因素和社会因素之间的关联，并采用先进的方法来基于多模态成像发现 B 期 HF 的亚表型有望产生新的结果。与个人和美国公共卫生高度相关的农村心血管健康知识。