Renin Angiotensin for Coronary Microvascular Dysfunction

描述(摘自匹兹堡大学的申请) 这一重新应用建议延长妇女缺血的随访时间 对患者进行至少5年的症状评估(WISE)，目前正在 与申请书一起提交的《改变的肾素血管紧张素系统作为 女性冠状动脉微血管功能障碍的机制“(C.Pepine Pi) 和“女性冠心病的免疫学基础”(S.Reis Oi)。智者 该合同始于1996年9月，是一项四中心研究，旨在优化症状 女性缺血性心脏病的评估和诊断试验：2) 探讨临床症状和心肌缺血的发病机制 心外膜冠状动脉狭窄：和3)评价 生殖激素对症状和诊断试验的反应。广泛的 当代数据库收集了936名转诊为冠心病的女性的数据 因为怀疑是缺血而进行了血管造影。数据包括人口统计、 临床、症状、功能和心理社会变量。冠状动脉 心血管造影术和脑室造影术数据，臂动脉反应性试验，心电图 监测和血液检测都是由核心实验室评估的， 特定地点-创新技术已被用来开发潜力 心肌缺血的标志物。我们寻求1)确定增量多头- WISE开发的新测试的长期预后价值：2)发展性别- 评估女性预后价值的特定增量结局模型 生殖变量：3)评估增量成本效益和 WISE创新测试技术资源与 传统测试：4)继续进行分析和辅助项目， 与在此群集中提交的其他WISE调查人员的R01合作，并 维护明智的数据库和基础设施，以便进一步 探讨女性脑缺血综合征的发病机制。至 为了实现这些目标，有必要进行更长时间的后续行动。后续行动将包括 由经验丰富的现场协调员进行年度电话联系。明智的意志 继续采用行之有效的方法实施研究协调， 数据管理、质量控制、统计分析和稿件 准备工作。将使用COX回归模型来分析具有 人口统计风险因素、诊断性检测和生殖因素 被认为是解释变量。将使用混合决策模型 它比较了资源使用模式，并计算了总成本。结果是 这些研究将使我们更好地理解 女性缺血性心脏病的病理生理学基础 旨在减少疾病的诊断和治疗临床试验- 相关发病率和死亡率。

DESCRIPTION (Abstract from University of Pittsburgh application) This reapplication proposes to extend the follow-up of the Women's Ischemia Syndrome Evaluation (WISE) patients for a minimum of 5 years and is being submitted jointly with the applications, "Altered Renin Angiotensin System as a Mechanism for Coronary Microvascular Dysfunction in Women" (C. Pepine PI) and "Immunologic Basis For Coronary Disease in Women" (S.Reis OI). The WISE contract began in September 1996 as a 4-center study to 1) optimize symptom evaluation and diagnostic testing for ischemic heart disease in women: 2) explore mechanisms for symptoms and myocardial ischemia in the absence of epicardial coronary artery stenoses: and 3) evaluate the influence of reproductive hormones on symptoms and diagnostic test response. An extensive contemporary database has been assembled on 936 women referred for coronary angiography because of suspected ischemia. Data include demographic, clinical, symptomatic, functional, and psychosocial variables. Coronary angiography and ventriculography data, brachial artery reactivity testing, ECG monitoring, and blood determinations are all assessed by core laboratories, Site-specific-innovative technologies have been used to develop potential markers of myocardial ischemia. We seek to 1) Determine the incremental long- term prognostic value of novel testing developed in WISE: 2) Develop sex- specific incremental outcome models to evaluate the prognostic value of female reproductive variables: 3) Assess the incremental cost effectiveness and resource of the WISE innovative testing techniques as compared with traditional tests: 4) Continue ongoing analyses and ancillary projects, collaborate with other WISE investigators' R01s submitted in this cluster and maintain a WISE database and infrastructure to facilitate further investigations into the mechanisms underlying ischemia syndromes in women. To address these aims, a longer follow-up is necessary. Follow-up will consist of annual telephone contacts by experienced site coordinators. WISE will continue to use the well-established methods to implement study coordination, data management, quality control, statistical analyses, and manuscript preparation. Cox regression models will be used to analysis events with demographics risk factors, diagnostic testing and reproductive factors considered as explanatory variables. A hybrid decision model will be used that compares resource use patterns and sums cost estates. The results of these studies will enhance our understanding of both the significance and pathophysiology of ischemic heart disease in women and serve as a foundation for diagnostic and therapeutic clinical trials aimed at reducing disease- related morbidity and mortality.