Utility of Lung Ultrasound in Assessing Pulmonary Congestion in Heart Failure

肺部超声在评估心力衰竭肺充血中的效用

• 批准号: 9042412
• 负责人: Elke Platz
• 金额: $ 18.87万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-04-01 至 2020-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9042412
• 关键词: Accident and Emergency department; Acute; Address; Affect; Age-Years; Area; Biometry; Biostatistical Methods; Boston; Cardiology; Cardiopulmonary; Cardiovascular system; Caring; Cessation of life; Chest; Clinical; Clinical Investigator; Clinical Markers; Clinical Trials; Clinical Trials Design; Detection; Diagnosis; Diagnostic; Dyspnea; Early treatment; Echocardiography; Emergency Medicine; Epidemiologic Methods; Epidemiology; Equipment; Europe; Evaluation; Event; Extravascular Lung Water; Goals; Grant; Health; Heart failure; Hospitalization; Hospitals; Image; Imaging Device; Imaging Techniques; Inpatients; Institution; Knowledge; Laboratory Markers; Length of Stay; Lung; Measures; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Methods; Monitor; Morbidity - disease rate; North America; Outcome; Patients; Physical Examination; Population; Process; Public Health; Quality of life; Quality-of-Life Assessment; Reporting; Research; Research Design; Research Personnel; Risk; Risk Management; Speed; Stratification; Surrogate Markers; Symptoms; Testing; Time; Titrations; Training; Training Programs; Translating; Ultrasonography; Undifferentiated; Universities; Woman; Work; Writing; adverse outcome; base; cardiovascular visualization; career; career development; clinical biomarkers; design; diagnostic accuracy; heart imaging; imaging biomarker; improved; mortality; novel; point of care; prognostic significance; prognostic value; programs; prospective; response; skills; tool; treatment response

 DESCRIPTION (provided by applicant): My goal in seeking a K23 Mentored Patient-Oriented Research Career Development Award is to acquire the knowledge and skills to become an independent clinical investigator and a leader in cardiopulmonary imaging research. I have a broad background in ultrasonography, with specific expertise in lung ultrasonography and point-of-care echocardiography which are key research areas for this application. I propose to investigate the relationship of pulmonary congestion assessed by lung ultrasound (LUS) and acute decompensated heart failure (ADHF). Pulmonary congestion, often manifested by breathlessness (dyspnea), is the most common sign of ADHF and the leading cause of hospitalization in the U.S. population over 65 years of age. Patient reported dyspnea is used both clinically and in trials as a surrogate marker of pulmonary congestion, because the detection and quantification of pulmonary congestion based on current methods remains challenging. Although patient symptoms represent an important treatment goal, there is a critical need for novel quantitative markers of pulmonary congestion. Lung ultrasound (LUS) is a novel, semi-quantitative tool in the assessment of pulmonary congestion that has been identified as a useful point-of-care tool in the evaluation of undifferentiated dyspnea. "B-lines" are vertical lins on LUS which, when quantified, provide a graded measure of extra-vascular lung water. Although LUS has been used clinically as a diagnostic tool in the acute care setting, little is known about the correlates, dynamic changes and prognostic value of this method. In aim 1, we will examine the cross-sectional association of baseline B-line number with conventional clinical, biomarker, and imaging correlates of congestion, as well as short term outcomes. In aim 2, we will determine the extent to which B-line number decreases in response to therapy. In aim 3, we will examine the association of pre- discharge B-line number with long term outcomes, including heart failure related readmissions and death. These aims will be investigated at two leading academic institutions with an extensive track record of heart failure and imaging research, as well as mentorship of early career investigators. The long term goal of this proposal is to improve the assessment of pulmonary congestion in patients with heart failure and to determine the extent to which LUS as a novel imaging tool can measure sub-clinical pulmonary congestion, guide titration of therapy, and predict adverse outcomes in this population. The proposed research will be conducted in the context of a comprehensive five-year career development training program with the goal of providing me with the knowledge and skills to become an independent clinical investigator in cardiopulmonary imaging research at the interface of emergency medicine and cardiology. A team of accomplished mentors and collaborators with expertise in cardiac imaging, heart failure, quality of life assessment, epidemiology, biostatistics, and clinical trials will guide me in my transition to scientific independence.

 描述（由申请人提供）：我寻求 K23 指导的以患者为导向的研究职业发展奖的目标是获得知识和技能，成为一名独立的临床研究者和心肺影像研究的领导者。我在超声检查方面拥有广泛的背景，在肺部超声检查和护理点超声心动图方面具有特定的专业知识，这是该应用的关键研究领域。我建议研究通过肺部超声（LUS）评估的肺充血与急性失代偿性心力衰竭（ADHF）的关系。肺充血通常表现为呼吸困难（呼吸困难），是 ADHF 最常见的症状，也是美国 65 岁以上人群住院的主要原因。患者报告的呼吸困难在临床和试验中被用作肺充血的替代标志，因为基于当前方法的肺充血的检测和量化仍然具有挑战性。尽管患者症状代表了重要的治疗目标，但仍迫切需要新的肺充血定量标记物。肺部超声 (LUS) 是一种评估肺充血的新型半定量工具，已被认为是评估未分化呼吸困难的有用的护理点工具。 “B 线”是 LUS 上的垂直线，量化后可提供血管外肺水的分级测量。尽管 LUS 已在临床上用作急性护理环境中的诊断工具，但对该方法的相关性、动态变化和预后价值知之甚少。在目标 1 中，我们将检查基线 B 线数量与常规临床、生物标志物和充血影像相关性以及短期结果的横截面关联。在目标 2 中，我们将确定 B 线数量因治疗而减少的程度。在目标 3 中，我们将检查出院前 B 线数量与长期结果的关联，包括心力衰竭相关的再入院和死亡。这些目标将在两个领先的学术机构进行研究，这些机构在心力衰竭和影像学研究方面拥有广泛的记录，并为早期职业研究人员提供指导。该提案的长期目标是改善心力衰竭患者肺充血的评估，并确定 LUS 作为一种新型成像工具可以在多大程度上测量亚临床肺充血、指导治疗滴定并预测该人群的不良后果。拟议的研究将在一个全面的五年职业发展培训计划的背景下进行，目的是为我提供知识和技能，使我成为急诊医学和心脏病学交叉领域心肺成像研究的独立临床研究者。一支由在心脏成像、心力衰竭、生活质量评估、流行病学、生物统计学和临床​​试验方面具有专业知识的优秀导师和合作者组成的团队将指导我向科学独立的过渡。