Ventricular remodeling and heart failure after myocardial infarction: a community

心肌梗死后心室重构和心力衰竭：社区

• 批准号: 8977419
• 负责人: MAURICE ENRIQUEZ-SARANO
• 金额: $ 74.25万
• 依托单位: MAYO CLINIC ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-01-15 至 2017-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8977419
• 关键词: 3-Dimensional; Acute; Address; Admission activity; Affect; Biological; Biological Markers; Cardiac; Cardiovascular Diseases; Characteristics; Cicatrix; Clinical; Clinical Trials; Communities; Complex; Coronary; Coronary heart disease; Data; Development; Diagnosis; Dilatation - action; EFRAC; Educational workshop; Epidemiology; Event; Excess Mortality; Extracellular Matrix; Face; Frequencies; Future; Goals; Health; Heart failure; Heterogeneity; Hospitalization; Image; Imaging Techniques; Incidence; Inflammation; Injury; Intervention; Knowledge; Left Ventricular Remodeling; Left atrial structure; Left ventricular structure; Measurement; Measures; Methods; Mitral Valve; Mitral Valve Insufficiency; Morbidity - disease rate; Muscle Cells; Myocardial; Myocardial Infarction; Myocardial dysfunction; National Heart, Lung, and Blood Institute; Pathway interactions; Patients; Pattern; Persons; Population; Prevention; Process; Publishing; Recommendation; Recovery; Recruitment Activity; Research; Risk; Role; Sampling; Severities; Shapes; Staging; Stress; Testing; Three-Dimensional Echocardiography; Time; Two-Dimensional Echocardiography; Ventricular; Ventricular Dysfunction; Ventricular Remodeling; clinical application; clinical biomarkers; clinical practice; clinical risk; clinically relevant; cohort; fibrogenesis; high risk; imaging biomarker; improved; indexing; innovation; insight; meetings; men; mortality; novel; novel marker; population based; prevent; prospective; study population; tool; two-dimensional; working group

DESCRIPTION (provided by applicant): Over the past 2 decades, major changes in the epidemiology of myocardial infarction (MI) have occurred. Progress in its acute treatment improved short term survival, but heart failure (HF) remains frequent after MI and leads to excess mortality. Hence, the acute treatment of MI aimed at restoring vessel patency is not sufficient to prevent HF, underscoring the importance of understanding the contemporary mechanisms leading to its development. The transition from the initial myocardial injury to ventricular dysfunction and HF is termed left ventricular remodeling and is characterized by progressive ventricular enlargement, alteration of systolic and diastolic function and occurrence of mitral regurgitation (MR). Remodeling is a dynamic entity, defined as a change over time, diagnosed at a stage where deleterious changes cannot be reversed. Hence, it must be predicted and prevented. Knowledge on cardiac remodeling after MI is incomplete, which hinders its prevention. Firstly, the exact incidence of remodeling remains to be defined as data pertain mostly to clinical trials, of uncertain clinical relevance. Secondly, the mechanisms of ventricular remodeling after MI remain to be defined with the goal of identifying novel predictors that could define targets for prevention and treatment. Thirdly, most imaging data on remodeling do not reflect state of the art methods or contemporary cohorts. Thus, addressing the frequency and mechanisms of remodeling after MI is needed to define strategies to prevent HF and requires relying on clinically relevant populations evaluated by rigorous imaging techniques integrated with measurements of novel biomarkers. Our 3 specific aims will help elucidate, within a prospective community cohort, the frequency and mechanisms of ventricular remodeling and the responsibilities of these mechanisms in the genesis of post MI HF. Aim 1 will measure the frequency and patterns of left ventricular remodeling after incident MI in a community-based population. Remodeling will be evaluated by two- and three-dimensional echocardiography and speckle tracking and defined as changes in systolic or diastolic function and MR. Aim 2 will assess the determinants of remodeling, including clinical characteristics and novel biomarkers. Aim 3 will test the value of the predictors of remodeling identified in Aim 2 to predict HF after MI. In Aims 1 and 2, we will recruit 420 patients to obtain serial two-dimensional and three-dimensional echocardiographic studies. Aim 3 will extend these findings to the entire population-based MI incidence cohort. Our proposed application comprises several key innovative aspects. Our ongoing surveillance of coronary disease will provide a strong recruitment platform and a robust backdrop to optimize the clinical relevance of our data. Rigorous imaging approaches will provide unique insights into the remodeling process. We will integrate imaging and biomarker data to identify predictors of remodeling that can be measured at index MI to enable risk prediction of HF in contemporary MI populations.

描述（由申请人提供）：在过去20年中，心肌梗死（MI）的流行病学发生了重大变化。其急性治疗的进展改善了短期生存率，但心肌梗死后心力衰竭（HF）仍很常见，并导致死亡率过高。因此，旨在恢复血管通畅性的MI急性治疗不足以预防HF，强调了了解导致其发展的当代机制的重要性。从最初的心肌损伤到心室功能障碍和HF的转变称为左心室重构，其特征在于进行性心室增大、收缩和舒张功能改变以及二尖瓣反流（MR）的发生。重塑是一个动态的实体，定义为随着时间的推移而发生的变化，在有害变化无法逆转的阶段进行诊断。因此，必须预测和预防。对心肌梗死后心脏重构的认识还不完全，这阻碍了其预防。首先，重塑的确切发生率仍有待确定，因为数据主要与临床试验有关，临床相关性不确定。其次，心肌梗死后心室重构的机制仍有待明确，目的是确定新的预测因子，以确定预防和治疗的靶点。第三，大多数关于重塑的成像数据并不反映最先进的方法或当代队列。因此，需要解决MI后重塑的频率和机制，以确定预防HF的策略，并需要依赖于通过严格的成像技术与新生物标志物的测量相结合的临床相关人群。我们的3个具体目标将有助于在前瞻性社区队列中阐明心室重构的频率和机制以及这些机制在MI后HF发生中的作用。目标1将测量社区人群中心肌梗死事件后左心室重塑的频率和模式。重塑将通过二维和三维超声心动图和斑点追踪进行评估，并定义为收缩或舒张功能和MR的变化。目标2将评估重塑的决定因素，包括临床特征和新的生物标志物。目标3将检验目标2中确定的重构预测因子预测MI后HF的价值。在目标1和2中，我们将招募420名患者，以获得连续二维图像。 和三维超声心动图研究。目标3将这些结果扩展到整个基于人群的MI发病率队列。我们提出的申请包括几个关键的创新方面。我们对冠状动脉疾病的持续监测将提供一个强大的招募平台和强大的背景，以优化我们数据的临床相关性。严格的成像方法将为重塑过程提供独特的见解。我们将整合成像和生物标志物数据，以确定重构的预测因子，这些预测因子可以在指数MI时测量，从而能够预测当代MI人群中的HF风险。