Improving Pulmonary Congestion Assessment in Heart Failure with Preserved Ejection Fraction

通过保留射血分数改善心力衰竭的肺充血评估

基本信息

批准号：
10610779
负责人：
Elke Platz
金额：
$ 41.58万
依托单位：
BRIGHAM AND WOMEN'S HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-07-15 至 2025-04-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10610779
关键词：
Acute Adult Affect Atrial Fibrillation Auscultation Biological Markers Cause of Death Cellular Phone Chronic Clinical Clinical assessments Computerized Medical Record Congestive Heart Failure Detection Devices Diagnosis Diagnostic Procedure Diuresis EFRAC Early Diagnosis Early Intervention Early identification Early treatment Echocardiography Emergency Department patient Evaluation Event Fluid overload Funding Future Generations Goals Health Heart failure Hospitalization Image Information Dissemination Laboratories Learning Liquid substance Lung Measures Methods Monitor Morbidity - disease rate Multi-Institutional Clinical Trial Natriuretic Peptides Obesity Online Systems Outpatients Patients Physical Examination Play Population Prevalence Prior Therapy Protocols documentation Publications Pump Quality of life Regulation Reporting Research Risk Risk Marker Role Symptoms Syndrome Thoracic Radiography Time Tissues Work adverse outcome cohort comorbidity cost diagnostic strategy economic impact evidence base experience hemodynamics high risk improved innovation mortality multidisciplinary novel novel strategies patient subsets point of care preservation pro-brain natriuretic peptide (1-76)prognostic prognostic value support tools technology validation tool ultrasound

项目摘要

ABSTRACT Heart failure with preserved ejection fraction (HFpEF) is a syndrome that is particularly difficult to diagnose and treat, yet, it is estimated to affect >50% of patients with HF. With >1 million hospitalizations for HF in the U.S. annually and one-year mortality rates up to 29%, the health and economic impact of HFpEF is substantial. The early detection of volume overload in the outpatient setting is critical to optimize decongestive therapy prior to frank decompensation requiring hospitalization. Pulmonary congestion, a hallmark of volume overload in HFpEF, plays a central role in the progression of decompensation ultimately leading to hospital admission. However, current diagnostic methods for its detection are insensitive. Our central hypothesis is that the assessment of pulmonary congestion by lung ultrasound (LUS) in HFpEF will outperform currently available approaches. LUS is a novel, non-invasive and inexpensive tool in the quantification of pulmonary congestion. With this study, we will expand our prior work to understand how this method could be utilized in an ambulatory setting to identify pulmonary congestion in patients with known or suspected HFpEF. Our long-term goal is to initiate early intervention, improve quality of life, and reduce HF hospitalizations and costs in this population. Our specific aims are: 1) Determine the prevalence of lung ultrasound findings of pulmonary congestion and their echocardiographic, biomarker and quality of life correlates in patients with HFpEF. 2A) Investigate the prognostic value of lung ultrasound-detected pulmonary congestion for adverse HF events in ambulatory patients with HFpEF. 2B) Develop and validate a congestion-focused risk score for ambulatory patients with HFpEF integrating clinical, ultrasound and biomarker findings. Our approach is innovative by focusing on new approaches to volume status assessment in a traditionally difficult to diagnose cohort of HFpEF patients, and employing an inexpensive point-of-care device paired with a time-efficient, easily learned imaging protocol. This proposal is significant because it will provide critically important information regarding the incremental value of LUS for the detection of pulmonary congestion in ambulatory patients with HFpEF. It is therefore a critical step toward improving the early detection of volume overload in patients at high risk for HF hospitalizations and the associated morbidity, mortality and cost.

抽象的心力衰竭和保留的射血分数（HFPEF）是一种综合征，特别难以诊断和但是，估计它会影响> 50％的HF患者。美国HF的住院率> 100万每年和一年的死亡率高达29％，HFPEF的健康和经济影响是巨大的。这在门诊环境中的早期检测到体积超负荷对于优化充气疗法至关重要弗兰克需要住院的弗兰克。肺部充血，体积超负荷的标志 HFPEF，在代偿性的进展中起着核心作用，最终导致医院入院。但是，目前的检测诊断方法不敏感。我们的核心假设是 HFPEF中肺超声（LUS）对肺部充血的评估将胜过当前可用的方法。 LUS是一种新型，无创和廉价的工具，用于定量肺部充血。通过这项研究，我们将扩大先前的工作，以了解如何在门诊中使用这种方法设置以识别已知或疑似HFPEF患者的肺部充血。我们的长期目标是开始早期干预，改善生活质量，并降低该人群的HF住院和成本。我们的具体目的是：1）确定肺部充血和他们的超声心动图，生物标志物和生活质量与HFPEF患者相关。 2a）调查肺部超声检测的肺部充血的预后价值，用于卧床中的不良HF事件 HFPEF患者。 2b）为具有拥end式的风险评分开发和验证 HFPEF整合了临床，超声和生物标志物发现。我们的方法是通过专注于新的创新性传统上难以诊断出HFPEF患者队列的数量状态评估方法，采用廉价的护理设备，搭配时间效率，易于学习的成像协议。该提案很重要，因为它将提供有关增量的至关重要的重要信息 HFPEF病人中检测肺部充血的LU值。因此，这是一个提高HF高风险患者的早期量超负荷的及早检测到的关键步骤住院以及相关的发病率，死亡率和成本。

项目成果

期刊论文数量（15）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

DOI：
10.1002/ejhf.2699
发表时间：
2023-01
期刊：
European journal of heart failure
影响因子：
18.2
作者：
通讯作者：

Ultrasound imaging of congestion in heart failure: examinations beyond the heart.

DOI：
10.1002/ejhf.2032
发表时间：
2021-05
期刊：
European journal of heart failure
影响因子：
18.2
作者：
Pellicori P;Platz E;Dauw J;Ter Maaten JM;Martens P;Pivetta E;Cleland JGF;McMurray JJV;Mullens W;Solomon SD;Zannad F;Gargani L;Girerd N
通讯作者：
Girerd N

Risk stratification in patients presenting with acute heart failure.

急性心力衰竭患者的危险分层。

DOI：
10.1093/ehjacc/zuab005
发表时间：
2021
期刊：
European heart journal. Acute cardiovascular care
影响因子：
0
作者：
Platz,Elke;Jhund,PardeepS
通讯作者：
Jhund,PardeepS

Sex differences in congestive markers in patients hospitalized for acute heart failure.

DOI：
10.1002/ehf2.13300
发表时间：
2021-06
期刊：
ESC heart failure
影响因子：
3.8
作者：
Espersen C;Campbell RT;Claggett B;Lewis EF;Groarke JD;Docherty KF;Lee MMY;Lindner M;Biering-Sørensen T;Solomon SD;McMurray JJV;Platz E
通讯作者：
Platz E

Prevalence and prognostic importance of lung ultrasound findings in acute coronary syndrome: A systematic review.