Profiling Biobehavioral Responses to Mechanical Support in Advanced Heart Failure

分析晚期心力衰竭对机械支持的生物行为反应

• 批准号: 8451264
• 负责人: Christopher Sean Lee
• 金额: $ 32.85万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-04-01 至 2016-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8451264
• 关键词: Acceleration; Activities of Daily Living; Acute; Address; Adult; Anxiety; Behavioral Research; Biological Markers; Breeding; Cardiovascular Diseases; Clinical; Clinical Management; Clinical Research; Complex; Data; Decision Making; Destinations; Devices; Education; Elderly; Eligibility Determination; Event; Exertion; Family; Functional disorder; Future; Goals; Growth; Health; Heart Transplantation; Heart failure; Heterogeneity; Hospitalization; Hostility; Inflammation; Intervention; Life; Link; Mechanics; Medical; Modeling; Monitor; Myocardial; Organ Donations; Outcome; Pain; Pathogenesis; Patients; Persons; Population; Process; Provider; Quality of life; Refractory; Research; Rest; Risk; Serum; Shapes; Stress; Symptoms; Technology; Testing; Time; United States; biobehavior; biological research; clinically relevant; cohort; depressive symptoms; follow-up; health related quality of life; implantation; improved; insight; patient oriented; psychologic; response; symptom management; time use; treatment strategy; ventricular assist device

DESCRIPTION (provided by applicant): Heart failure (HF) is the fastest growing cardiovascular disorder in the U.S., and the most common reason for hospitalization among older adults. Many patients with HF have symptoms at rest or with minimal exertion that become refractory to optimal medical therapy. Fewer than 5% of these advanced HF patients are eligible for heart transplantation, and organ donations are extremely limited. As such, mechanical circulatory support with a ventricular assist device (VAD) has emerged as a primary treatment for advanced HF. There is significant and unexplained heterogeneity in clinical outcomes and quality-of-life after VAD implantation. Moreover, we know very little about how physical and psychological symptoms may relate to changes in underlying HF pathogenesis and how symptoms and pathogenic biomarkers may explain differential responses to VAD implantation. Accordingly, our research goals are to a) characterize common and distinct trajectories of change in symptoms and pathogenic biomarkers during the transition from advanced HF through the first 6 months after VAD implantation, and b) link changes in symptoms and biomarkers over time to clinical events and quality-of-life. We will collect data from a cohort of 120 adults with advanced HF prior to, and for a period of 6 months after VAD implantation. Our aims are to: 1) identify common trajectories of change in physical and psychological symptoms, 2) characterize common trajectories of change in serum biomarkers of myocardial stress, systemic inflammation, and endothelial dysfunction, and 3) quantify associations between symptoms and biomarkers of pathogenesis in adults undergoing VAD implantation. Importantly, we will codify the clinical relevance of different symptom and biomarker trajectories in terms of clinical-event risk and health-related quality-of-life. This interdisciplinary clinical research integrates and advances prior biological and behavioral research and is centered on an advanced technological treatment of a high profile cardiovascular disorder. These research findings will be used to enhance shared patient and provider decision-making regarding VAD implantation, and to shape a much-needed new breed of interventions and clinical management strategies that are tailored to differential symptom and pathogenic responses to VAD implantation.

描述(申请人提供)：心力衰竭(HF)是美国增长最快的心血管疾病，也是老年人住院治疗的最常见原因。许多心力衰竭患者在休息或轻微运动时会出现症状，这对最佳的药物治疗是很困难的。这些晚期心力衰竭患者中有资格接受心脏移植的不到5%，器官捐赠极其有限。因此，使用心脏辅助装置(VAD)的机械循环支持已成为晚期心力衰竭的主要治疗方法。VAD植入后的临床结果和生活质量存在着显著且无法解释的异质性。此外，我们对生理和心理症状如何与潜在的心力衰竭发病机制的变化有关，以及症状和致病生物标记物如何解释VAD植入后的差异反应知之甚少。因此，我们的研究目标是a)描述从晚期心力衰竭到VAD植入后前6个月期间症状和致病生物标记物变化的共同和独特的轨迹，以及b)将症状和生物标记物随时间的变化与临床事件和生活质量联系起来。我们将收集120名成年晚期心力衰竭患者在VAD植入前和植入后6个月的数据。我们的目标是：1)确定生理和心理症状的共同变化轨迹，2)表征心肌应激、全身炎症和内皮功能障碍的血清生物标记物的共同变化轨迹，3)量化成人VAD植入后症状和发病机制生物标记物之间的关系。重要的是，我们将根据临床事件风险和与健康相关的生活质量来编纂不同症状和生物标记物轨迹的临床相关性。这项跨学科的临床研究整合并推进了先前的生物和行为研究，并以一种备受瞩目的心血管疾病的先进技术治疗为中心。这些研究成果将被用来加强患者和提供者对VAD植入的共享决策，并形成亟需的新型干预和临床管理策略，这些干预和临床管理策略是针对VAD植入的不同症状和致病反应而量身定做的。