Ventricular and Pulmonary Vascular Reserve after the Fontan Operation

Fontan 手术后心室和肺血管储备

• 批准号: 10133126
• 负责人: Alexander Egbe
• 金额: $ 17.33万
• 依托单位: MAYO CLINIC ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-04-01 至 2021-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10133126
• 关键词: Address; Adult; Arrhythmia; Award; Blood; Blood Circulation; Blood Vessels; Blood flow; Bypass; Cardiac Catheterization Procedures; Cardiopulmonary; Cardiovascular Physiology; Caring; Catheterization; Central venous pressure; Chronic; Chronic Kidney Failure; Cirrhosis; Clinic; Clinical; Clinical Investigator; Common Ventricle; Complex; Congestive; Data; Deterioration; Diagnostic; Disease; Disease Progression; Early identification; Echocardiography; Exercise; Exercise Physiology; Exercise Test; Exposure to; Failure; Fontan Procedure; Functional disorder; Goals; Gold; Grant; Health Care Costs; Healthcare; Heart failure; Hemodynamic Processes; Hypertension; Intervention; Knowledge; Lead; Life Expectancy; Literature; Low Cardiac Output; Lung; Mentors; Mentorship; Methodology; Methods; Morbidity - disease rate; Natural History; North America; Organ; Outcome; Outcome Measure; Patient Care; Patient Outcomes Assessments; Patient Recruitments; Patients; Physiology; Population; Prevalence; Prevention strategy; Protein-Losing Enteropathies; Public Health; Pulmonary Circulation; Research; Research Design; Research Personnel; Resources; Rest; Risk Management; Role; Side; Stress; Supination; Thromboembolism; Time; Vascular Diseases; Venous; Ventricular; Work; career; cohort; comorbidity; congenital heart disorder; electric impedance; experience; follow-up; hemodynamics; improved; innovation; mortality; novel; operation; palliation; pressure; prevent; programs; response; risk stratification; skills; symptom management; tool; treatment strategy

PROJECT SUMMARY CANDIDATE: Dr. Egbe's long-term goal is to become an independent clinical investigator in the field of adult congenital heart disease. His short-term goal is to study new and unexplored aspects of hemodynamics and clinical outcomes in people with Fontan palliation. To achieve these goals, Dr. Egbe plans to: (1) Acquire expertise in advanced statistical methodology, exercise physiology and hemodynamics, and management of circulatory failure in people with Fontan physiology; (2) Develop new collaborative relationships with other researchers; (3) Submit RO1 proposals during the 3rd and 5th years of the award. ENVIRONMENT: The Mayo Clinic is a world-renowned center for innovation and research, and the Adult Congenital Heart Disease program at Mayo Clinic cares for the largest cohort of Fontan patients in North America, making it ideal for patient recruitment for the proposed studies. Dr. Borlaug, the primary mentor for this grant, is an expert in exercise hemodynamics and cardiovascular physiology, and has a track record of successful mentorship. RESEARCH Background: Patients with Fontan palliation have significantly reduced long-term survival because of Fontan associated diseases (FAD). Available data suggest that FAD are downstream complications of chronic venous congestion, but there is paucity of data about the upstream hemodynamic processes, such as pulmonary vascular disease (PVD) and ventricular diastolic dysfunction (VDD), responsible for chronic venous congestion and FAD. We will address these gaps in knowledge through the proposed studies. Specific Aims: We will determine the prevalence of PVD and VDD in patients with Fontan physiology using invasive and noninvasive hemodynamic cardiopulmonary exercise testing (Aims #1 and #2), and then evaluate the impact of rest-exercise PVD and VDD on clinical outcomes (Aim #3). Study Design and Outcome Measures: The studies will be conducted on adult Fontan patients undergoing cardiac catheterization for clinical indications at Mayo Clinic Rochester, MN. Simultaneous cardiac catheterization and echocardiography will be performed at rest and during exercise (Aims #1 and #2), and the occurrence of rest-exercise PVD and VDD will be correlated with clinical outcomes during follow-up (Aim#3). Potential Public Health Contribution: Identifying and treating the early stages of PVD and VDD will potentially prevent or at least deter FAD, improve survival and reduce healthcare cost in this population. Relationship to the Career Goals of the Candidate: The data and skill set acquired during these projects will form the basis for an RO1 application focused on modifying the natural history of FAD, a critical step towards becoming an independent clinical investigator in this field.

项目概要 候选人：Egbe博士的长期目标是成为成人领域的独立临床研究者 先天性心脏病。他的短期目标是研究血流动力学和未探索的新方面 Fontan 姑息治疗患者的临床结果。为了实现这些目标，Egbe 博士计划：(1) 收购 先进统计方法、运动生理学和血流动力学以及管理方面的专业知识 患有 Fontan 生理学的人会出现循环衰竭； (2) 与他人建立新的合作关系 研究人员； （3）在奖项第3年和第5年期间提交RO1提案。 环境：梅奥诊所是世界著名的创新和研究中心，成人 梅奥诊所的先天性心脏病项目为北部最大的 Fontan 患者群体提供护理 美国，使其成为拟议研究的患者招募的理想选择。 Borlaug 博士，主要导师 此项资助是运动血流动力学和心血管生理学方面的专家，并且拥有以下记录： 成功的指导。 研究 背景：由于 Fontan 姑息治疗，患者的长期生存率显着降低 相关疾病（FAD）。现有数据表明 FAD 是慢性静脉血栓的下游并发症 充血，但缺乏有关上游血流动力学过程的数据，例如肺 血管疾病（PVD）和心室舒张功能障碍（VDD），导致慢性静脉充血 和FAD。我们将通过拟议的研究来解决这些知识差距。 具体目标：我们将使用 Fontan 生理学方法确定 PVD ​​和 VDD 患者的患病率 有创和无创血流动力学心肺运动测试（目标#1和#2），然后评估 休息运动 PVD ​​和 VDD 对临床结果的影响（目标#3）。 研究设计和结果衡量：该研究将对接受 Fontan 治疗的成年患者进行 明尼苏达州罗彻斯特梅奥诊所的临床适应症心导管插入术。同时心脏 导管插入术和超声心动图检查将在休息和运动期间进行（目标#1和#2），并且 休息运动 PVD ​​和 VDD 的发生将与随访期间的临床结果相关（目标#3）。 潜在的公共卫生贡献：识别和治疗早期阶段的 PVD ​​和 VDD 将 可能预防或至少阻止 FAD、提高该人群的生存率并降低医疗费用。 与候选人职业目标的关系：在这些项目中获得的数据和技能将 形成 RO1 应用的基础，重点是改变 FAD 的自然历史，这是迈向的关键一步 成为该领域的独立临床研究者。

项目成果

Long-Term Outcomes in Patients With Turner Syndrome: A 68-Year Follow-Up.

特纳综合征患者的长期结果：68 年随访。

• 发表时间: 2019
• 影响因子: 5.4
• 作者: Fuchs, Margaret M;Attenhofer Jost, Christine;Babovic;Connolly, Heidi M;Egbe, Alexander
• 通讯作者: Egbe, Alexander

Increased prevalence of left ventricular diastolic dysfunction in adults with repaired coarctation of aorta.

主动脉缩窄修复成人左心室舒张功能障碍的患病率增加。

• 发表时间: 2020-06
• 作者: Egbe, Alexander C;Miranda, William R;Connolly, Heidi M
• 通讯作者: Connolly, Heidi M

Left Ventricular Remodeling After Transcatheter Versus Surgical Therapy in Adults With Coarctation of Aorta.

成人主动脉缩窄经导管与手术治疗后的左心室重塑。

• 发表时间: 2020
• 作者: Egbe, Alexander C;Anderson, Jason H;Ammash, Naser M;Taggart, Nathaniel W
• 通讯作者: Taggart, Nathaniel W

Potential Benefits of Ambulatory Blood Pressure Monitoring in Coarctation of Aorta.

动态血压监测对主动脉缩窄的潜在益处。

• 发表时间: 2020-04-28
• 影响因子: 24
• 作者: Egbe, Alexander C;Miranda, William R;Bonnichsen, Crystal R;Warnes, Carole A;Connolly, Heidi M
• 通讯作者: Connolly, Heidi M

Outcomes of Pregnancy in Patients With Prior Right Ventricular Outflow Interventions.

既往接受过右心室流出道干预的患者的妊娠结局。

• 发表时间: 2019
• 影响因子: 5.4
• 作者: Egbe, Alexander C;El;Miranda, William R;Ammash, Naser M;Rose, Carl H;Fatola, Ayotola;Kothapalli, Srikanth;Abdelsamid, Mohamed Farouk;Connolly, Heidi M
• 通讯作者: Connolly, Heidi M