Epidemiologic Determinants of Cardiac Structure and Function in Rural Residents: RURAL ECHO

摘要 美国南部的农村成年人患有不成比例的心血管疾病(CVD)负担， 死亡率。阿巴拉契亚和密西西比三角洲(AMD)地区尤其危险，嵌入中风， 心脏病发作和心力衰竭(HF)死亡带，其中决定因素是多因素的。超声心动图 是研究心血管疾病和确定心力衰竭高危影像表型的理想方法 由于它能够同时无创地评估心脏结构和功能。由于过量的 在AMD地区的心血管疾病，因此我们预计心脏结构和功能异常的发生率很高 在农村成年人中，但这一点还没有明确显示出来。农村基础设施建设融资风险研究 纵向(农村)队列研究，通过评估广泛的表型、生物和社会决定因素 健康是一个独特的、具有成本效益的机会，可以实施一项研究，以填补所述的差距，减少 增加心血管疾病负担，实现所有美国人的健康公平。这项提议的长期目标是 了解在没有症状的情况下(即B期心衰)心脏不良重塑的负担 AMD区域及其影响因素，以便在亚临床疾病状态期间进行干预可避免 晚年的临床性心衰。这个应用程序的总体目标是建立一个独特的队列，名为农村 ECHO(农村居民心脏结构和功能的超声心动图决定因素)使用 家长研究的流动检查单元(MEU)的基础设施-“轮子上的诊所”-我们将执行 使用一种新的超声心动图对所有参与者进行基线超声心动图，以表征心脏结构和功能 人工智能(AI)回声方法。我们的中心假设是B阶段有很大的负担 HF，它与跨越多个领域的暴露有关。我们将通过以下方式实现我们的目标 这些具体目标：(目标1)使用AI Echo和细致的核心实验室分析来广泛表征心脏 农村研究队列中的结构和功能及其对部署人工智能对公共卫生影响的影响 农村环境中的回声；(目标2)确定人工智能回声结果与已知传统生物风险的关联 因素和共病；以及(目标3)确定AI Echo结果与新兴社会 并确定这些关联是否由传统的生物风险因素和 合并症。拟议的研究将提供最大和最全面的超声心动图数据集 专注于农村成年人，并将第一个理清该协会的程度和相对重要性 农村成人B期心力衰竭的生物与社会因素间的关系农村回声承诺产生新的 与个人和美国公共卫生高度相关的农村心血管健康知识。

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 objective of this application is to establish a unique cohort, named RURAL Echo (Echocardiographic Determinants of Cardiac Structure and Function in Rural Residents). 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. 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 the RURAL study cohort with implications for public health impact of deploying AI echo in rural settings; (Aim 2) Determine associations of AI Echo findings with known traditional biologic risk factors and comorbidities; and (Aim 3) Determine associations of AI Echo findings with emerging social determinants of health and establish if these associations are mediated by traditional biologic risk factors and comorbidities. The proposed study will provide the largest and most comprehensive echocardiographic dataset focused on rural adults, and will be the first to untangle the degree and relative importance of the association between biologic and social factors on Stage B HF among rural adults. RURAL Echo promises to yield new knowledge on rural cardiovascular health that is highly relevant to individual and US public health.