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

摘要 美国南部的农村居民成年人遭受不成比例的心血管疾病（CVD）负担， mortality.阿巴拉契亚和密西西比三角洲（AMD）地区的风险特别高，嵌入在中风， 心脏病发作和心力衰竭（HF）死亡带，其中的决定因素是多因素的。超声心动 是研究心血管疾病和确定心衰高危影像表型的理想方法 这是因为它能够同时无创地评估心脏结构和功能。由于过量的 因此，我们预期AMD地区的心血管疾病患病率较高，心脏结构和功能异常 在农村成年人中，这一点尚未明确显示。NHLBI资助的农村地区潜在风险 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 这是一个独特的、具有成本效益的机会，可以开展一项研究，填补上述空白， 减轻心血管疾病负担，实现所有美国人的健康公平。该提案的长期目标是 了解在没有症状的情况下不良心脏重塑的负担（即，阶段B HF） AMD区域及其促成因素，以便在亚临床疾病状态期间进行干预， 在以后的生活中临床HF。本申请的总体目标是建立一个独特的队列，名为农村 超声心动图（农村居民心脏结构和功能的超声心动图决定因素）使用 母研究的移动的检查单元（MEU）的基础设施-“车轮上的诊所”-我们将执行 在基线时对所有参与者进行超声心动图检查，以使用一种新的 人工智能（AI）回声方法。我们的中心假设是B期存在显著的负担 HF，与跨多个领域的暴露相关。我们将通过以下方式实现目标： 这些具体目标：（目标1）使用AI Echo和细致的核心实验室分析， 农村研究队列的结构和功能，以及部署AI对公共卫生影响的影响 农村地区的超声心动图;（目的2）确定AI超声心动图结果与已知传统生物学风险的相关性 因素和合并症;以及（目标3）确定AI Echo结果与新兴社会 健康的决定因素，并确定这些关联是否由传统的生物风险因素介导， 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 该研究的重点是农村成年人，它将是第一个解开这种关联的程度和相对重要性的研究。 在农村成年人中，生物和社会因素对B期HF的影响。农村回声承诺产生新的 农村心血管健康知识与个人和美国公共卫生高度相关。

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.