Left Atrial abNormality, ThromboEmbolism, and Race: Novel risk factors for stroke (LANTERN)

左心房异常、血栓栓塞和种族：中风的新危险因素 (LANTERN)

• 批准号: 9270634
• 负责人: Hooman Kamel
• 金额: $ 41.7万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-06-01 至 2020-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9270634
• 关键词: Address; Admission activity; African American; Ancillary Study; Anticoagulants; Atrial Fibrillation; Biology; Blood coagulation; Body Surface Area; Body mass index; Brain; Cardiac; Clinical; Data; Demographic Factors; Dilatation - action; Disease; Echocardiography; Electrocardiogram; Etiology; Face; Fibrosis; Fostering; Future; Heart; Heart Atrium; High Prevalence; Hypertrophy; Image; Incidence; Individual; Ischemic Stroke; Kentucky; Lead; Left; Left atrial structure; Light; Link; Longitudinal cohort study; Measurement; Measures; Mediating; Mission; Modeling; National Institute of Neurological Disorders and Stroke; Oral; Outcome; Pathogenesis; Patients; Pharmaceutical Preparations; Play; Population; Prevalence; Public Health; Race; Reporting; Research; Risk; Risk Factors; Risk Marker; Role; Source; Stroke; Stroke prevention; Testing; Therapeutic Embolization; Therapeutic Intervention; Thromboembolism; Time; Tissues; Visit; Work; biracial; black/white disparity; design; epidemiology study; experience; geographic difference; heart rhythm; high risk; improved; nervous system disorder; novel; population based; racial difference; racial disparity; screening

PROJECT SUMMARY/ABSTRACT African Americans face a two-fold higher risk of ischemic stroke than white residents of the U.S. The reasons for this black-white stroke disparity are not completely known. This proposal seeks to identify whether atrial cardiopathy, a novel risk factor, partly explains the higher stroke risk in blacks. Compared to whites, blacks experience less atrial fibrillation, a heart-rhythm disorder that is one of the strongest known risk factors for stroke. In the prevailing clinical paradigm, it is thought that atrial fibrillation is required for blood clots to form in the heart's left atrium, from where they can embolize to the brain and cause stroke. However, recent research indicates that embolization from the left atrium can occur when there are abnormalities in atrial tissue and function—a condition referred to as atrial cardiopathy—regardless of whether there is atrial fibrillation. Preliminary data suggest that atrial cardiopathy manifests differently in blacks than whites: more often with left atrial abnormality on a 12-lead electrocardiogram (ECG) and less often with atrial fibrillation or its typical accompaniment, left atrial enlargement on an echocardiogram. As a result, atrial thromboembolism may often go unrecognized in blacks because it occurs in the absence of atrial fibrillation and atrial enlargement. The proposed research will test the central hypothesis that currently unexplained disparities in stroke between whites and blacks can be partly explained by differences in the manifestation of atrial cardiopathy. This application is for an ancillary study to the REasons for Geographic and Racial Differences in Stroke (REGARDS) study and the Greater Cincinnati/Northern Kentucky Stroke Study (GCNKSS). REGARDS is a longitudinal cohort study that seeks to shed light on the relationship between baseline risk factors and future stroke in >30,000 black and white individuals. GCNKSS is a population-based epidemiological study of racial disparities in the incidence and outcomes of stroke in a biracial population of 1.3 million. Taking advantage of the complementary designs of these studies, the proposed research will first determine the relationship between baseline ECG-defined left atrial abnormality, race, and future stroke in REGARDS. It will then determine black-white differences in GCNKSS in markers that signify a potential atrial thromboembolic cause of stroke. Specific Aim 1 will test the hypotheses that blacks have a higher prevalence of left atrial abnormality, that left atrial abnormality is associated with future stroke, and that left atrial abnormality contributes to the higher stroke risk in blacks. Specific Aim 2 will test the hypotheses that black patients with ischemic stroke more often have ECG-defined left atrial abnormality and less often have echocardiographic left atrial enlargement than whites. All ECGs and a subset of echocardiogram images will be centrally interpreted. This research promises to show that blacks' higher stroke risk partly reflects actionable differences in the biology of stroke. Such findings may ultimately lead to therapy using existing medications approved for atrial fibrillation.

项目摘要/摘要 非裔美国人面临的缺血性中风风险高于美国白人居民 这种黑白中风差异的原因尚不完全清楚。该建议旨在确定是否 心房病变是一种新型的危险因素，部分解释了黑人的中风风险较高。与白人相比 黑人经历较少的房颤，这是一种心律失常，这是已知的强烈危险因素之一 中风。在流行的临床范式中，人们认为血块形成需要心房颤动 在心脏的左心房中，他们可以从那里栓塞到大脑并引起中风。但是，最近 研究表明，当心房组织异常时，左心房的栓塞可能会发生 功能 - 一种称为心房心脏病的疾病 - 没有任何心房颤动。 初步数据表明，心房的心脏病在黑人中的表现与白人不同：左 12铅心电图（ECG）的心房异常，而在房颤或典型的情况下较少 伴奏，超声心动图上的左心房增强。结果，心房血栓栓塞可能经常 在黑人中无法识别，因为它发生在缺乏心房颤动和心房膨胀的情况下。这 拟议的研究将检验中心假设，即目前无法解释的中风分布 白人和黑人可以部分通过心房心脏病表现的差异来解释。这 应用是辅助研究的，原因是中风的地理和种族差异的原因 （有关）研究和大辛辛那提/北部肯塔基州中风研究（GCNKSS）。问候为 纵向队列研究试图阐明基线风险因素与未来之间的关系 中风> 30,000个黑白个人。 GCNKSS是一项基于人群的种族流行病学研究 该事件的差异和中风的结果为130万。利用 这些研究的完整设计，拟议的研究将首先确定关系 在基线ECG定义的左心房异常，种族和未来中风之间。然后会 确定标记中GCNKSS的黑白差异，这些差异表示潜在的心房血栓栓塞原因 中风。特定的目标1将检验黑人左心异常患病率较高的假设， 剩下的心房异常与未来的中风有关，而心房异常有助于 黑人的中风风险更高。特定的目标2将检验缺血性中风黑人患者的假设 经常有ECG定义的左心房异常，较少的超声心动图离开心房 比白人扩大。所有心电图和超声心动图图像的子集将被集中解释。这 研究有望表明，黑人的中风较高风险部分反映了可行的生物学差异 中风。这样的发现最终可能会使用批准用于心房颤动的现有药物进行治疗。