P Wave Indices: Risk Prediction and Cardiovascular Outcomes

说明(申请人提供)：房颤(AF)目前的患病率估计为230万人，中风风险增加3-5倍，心力衰竭风险增加3倍，死亡风险增加1.5-1.9倍。这项研究将整合P波指数，这是一种新的心电图表型，并确定它们对房颤、中风和死亡率风险预测的贡献。P波指数由P波持续时间、离散度、波幅、面积和终末力来描述，反映了心房的电生理和形态，因此是心房组织功能的晴雨表。这项研究有三个目标。首先，它将在弗雷明翰心脏研究(FHS)中开发P波指数的表型。其次，它将在FHS和社区动脉粥样硬化风险(ARIC)研究中评估与P波指数相关的遗传变异。第三，它将开发和校准这两个队列中房颤、心力衰竭和死亡率的风险模型。模型将在ARIC中开发，然后在FHS中进行验证和复制。这项研究设计促进了具有互补人口统计学和表型特征的队列之间的合作，并利用先前建立的合作来预测房颤风险。P波指数的流行病学、预后价值和遗传决定因素尚未完全描述。我们的努力将有助于在ARIC和FHS研究中理解房颤、心力衰竭和死亡率的风险建模。这项研究将对P波指数与终点的关联做出独特的贡献。最终，这样的努力将阐明P波指数是如何指示值得干预的重要生理过程的。2/5/2010

DESCRIPTION (provided by applicant): Atrial fibrillation (AF) has a currently estimated prevalence of 2.3 million people and increases stroke risk by 3-5 fold, heart failure risk by 3 fold and mortality risk by 1.5 to 1.9 times. The study will integrate P wave indices, a novel electrocardiographic (ECG) phenotype, and determine their contribution to risk prediction for AF, stroke and mortality. P wave indices, described by P wave duration, dispersion, amplitude, area, and terminal force, reflect atrial electrophysiology and morphology and are consequently a barometer of atrial tissue function. The study has three aims. First, it will develop the phenotype of P wave indices in the Framingham Heart Study (FHS). Second, it will assess the genetic variants associated with P wave indices in the FHS and the Atherosclerosis Risk in Communities (ARIC) study. Third, it will develop and calibrate risk models for AF, heart failure and mortality across these two cohorts. Models will be developed in ARIC and then validated and replicated in FHS. The study design facilitates collaboration between cohorts with complementary demographics and phenotypic characterization, and leverages previously established collaborations for AF risk prediction. The epidemiology, prognostic value and genetic determinants of P wave indices have been incompletely described. Our efforts will contribute towards understanding risk modeling for AF, heart failure, and mortality within the ARIC and FHS studies. The study will make unique contributions towards the association of P wave indices and the end- points. Ultimately, such an effort will elucidate how P wave indices, easily accessible from the surface ECG, may indicate important physiologic processes that merit intervention. 2/5/2010