Utility of Lung Ultrasound in Assessing Pulmonary Congestion in Heart Failure

 描述（由申请人提供）：我在寻求K23指导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，成为一个独立的临床研究者和心肺成像研究的领导者。我在超声检查方面有广泛的背景，在肺部超声检查和床旁超声心动图方面有特殊的专业知识，这是该应用的关键研究领域。本研究拟探讨肺超声（LUS）评估的肺充血与急性失代偿性心力衰竭（ADHF）之间的关系。肺充血，通常表现为呼吸困难（呼吸困难），是ADHF最常见的体征，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上和试验中均用作肺充血的替代标志物，因为基于当前方法的肺充血检测和定量仍然具有挑战性。尽管患者症状代表了重要的治疗目标，但迫切需要新的肺充血定量标记物。肺部超声（LUS）是一种新型的半定量评估肺充血的工具，已被确定为一个有用的床旁工具，在评估未分化的呼吸困难。“B线”是LUS上的垂直林斯，当量化时，其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线数量与充血的常规临床、生物标志物和成像相关性以及短期结局的横断面相关性。在目标2中，我们将确定治疗后B线数量减少的程度。在目标3中，我们将检查出院前B线数量与长期结局的相关性，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调查，这些机构拥有广泛的心力衰竭和成像研究记录，以及早期职业调查人员的指导。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测量亚临床肺充血的程度，指导治疗滴定，并预测该人群的不良结局。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，目标是为我提供知识和技能，使我成为急诊医学和心脏病学接口心肺成像研究的独立临床研究者。一个由在心脏成像、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有成就的导师和合作者组成的团队将指导我向科学独立过渡。

 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.