Ocular Fundus Abnormalities for Acute Risk Stratification in TIA and Minor Stroke

TIA 和轻微中风急性风险分层的眼底异常

• 批准号: 9281911
• 负责人: NANCY J NEWMAN
• 金额: $ 34.13万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-30 至 2019-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9281911
• 关键词: Accident and Emergency department; Acute; Affect; Age; American; Back; Biological Markers; Blood Pressure; Blood Vessels; Brain; Cardiovascular Diseases; Cardiovascular system; Cessation of life; Clinical; Cohort Studies; Complex; Consultations; Data; Diabetes Mellitus; Diagnosis; Diagnostic; Diffusion Magnetic Resonance Imaging; Embolism; Emergency Department Physician; Epidemiology; Evaluation; Event; Eye; Focal Neurologic Deficits; Fundus; Fundus photography; Future; Heart failure; Hospitals; Hour; Hypertension; Hypertensive Retinopathy; Hypoglycemia; Infarction; Injury; Ischemic Stroke; Meta-Analysis; Microaneurysm; Migraine; Minor; Mydriasis; Myocardial Infarction; Neuraxis; Neurologic; Neurologic Symptoms; Neurologist; Ophthalmology; Ophthalmoscopy; Optic Nerve; Outcome; Patients; Photography; Physical Examination; Prospective Studies; Research; Retina; Retinal; Retinal Hemorrhage; Retinal Vascular Occlusion; Risk; Risk Factors; Risk Reduction; Risk stratification; Seizures; Services; Severities; Stroke; Symptoms; Syncope; Testing; Time; Tissues; Transient Ischemic Attack; Translating; Universities; Unstable angina; Validation; Ventricular Arrhythmia; accurate diagnosis; base; cerebrovascular; clinical care; clinically relevant; cost; cotton wool spots; high risk; improved; neuroimaging; prospective; public health relevance; tool

DESCRIPTION (provided by applicant): Transient ischemic attack (TIA) and minor strokes affect hundreds of thousands of Americans each year. Up to 20% of patients affected by TIA and minor stroke will have a new, often disabling, stroke or cardiovascular event within 90 days, with the majority of these new events occurring in the first few hours and days after the initial events. Significant research has been focused on creating validated, easy-to-use tools that provide clinicians with accurate estimates of stroke risk after TIA and minor stroke, but there is substantial room for improvement. Ophthalmology has an important opportunity to assist with this difficult problem because the ocular fundus is the only place where part of the central nervous system (CNS) and its associated microvasculature can be directly visualized non-invasively. Based on our preliminary data, we hypothesize that acute retinopathic and vasculopathic changes in the ocular fundus (optic nerve and retina) are not only biomarkers of acute CNS tissue injury, but provide severity information about other important stroke risk factors (e.g., hypertension and diabetes). We propose a prospective, observational cohort study to validate and replicate our early results in a fully-powered study of 760 subjects. We will assess ocular fundus abnormalities using non-mydriatic photography, which allows high quality photographs of the optic nerve and retina to be taken without dilation of the pupils. Our aims are (1) to determine whether abnormalities of the ocular fundus are an independent predictor, above and beyond that of other clinical features and neuroimaging studies, of short-term (i.e., within 90 days) clinical outcomes (new stroke, cardiovascular events, and death) in patients presenting with TIA and minor stroke, and (2) to determine whether abnormalities of the ocular fundus among patients with suspected TIA differentiate patients with cerebrovascular diagnoses vs. those with non- cerebrovascular diagnoses. We will conduct the project at three Emory University-affiliated hospital's emergency departments and stroke services. Our project has the potential to translate our preliminary epidemiological findings into clinical care and improve the evaluation of TIA and minor stroke with a low-cost, universally available, but underutilized, aspect of the physical examination that when augmented by non- mydriatic fundus photography provides improved diagnostic capabilities and the potential for telemedical consultation when additional expertise is required.

描述（由申请人提供）：短暂性脑缺血发作（TIA）和轻微中风每年影响数十万美国人。高达 20% 的 TIA 和轻微中风患者会在 90 天内发生新的、通常致残的中风或心血管事件，其中大多数新事件发生在初始事件发生后的最初几个小时和几天内。重要的研究重点是创建经过验证、易于使用的工具，为临床医生提供 TIA 和轻微中风后中风风险的准确估计，但仍有很大的改进空间。眼科有一个重要的机会来帮助解决这个难题，因为眼底是唯一可以非侵入性地直接观察中枢神经系统（CNS）及其相关微血管系统部分的地方。根据我们的初步数据，我们假设眼底（视神经和视网膜）的急性视网膜病变和血管病变不仅是急性中枢神经系统组织损伤的生物标志物，而且提供了有关其他重要中风危险因素（例如高血压和糖尿病）的严重程度信息。我们提出了一项前瞻性、观察性队列研究，以在 760 名受试者的全面研究中验证和复制我们的早期结果。我们将使用免散瞳摄影来评估眼底异常，这样可以在不散瞳的情况下拍摄视神经和视网膜的高质量照片。我们的目标是 (1) 确定眼底异常是否是短期（即 90 年内）的独立预测因子，高于其他临床特征和神经影像学研究的预测因子。 天）出现 TIA 和轻微中风的患者的临床结果（新发中风、心血管事件和死亡），以及 (2) 确定疑似 TIA 患者的眼底异常是否能够区分脑血管诊断患者与非脑血管诊断患者。我们将在埃默里大学附属三家医院的急诊科和中风服务中心开展该项目。我们的项目有潜力将我们的初步流行病学发现转化为临床护理，并通过低成本、普遍可用但未充分利用的体检方式来改善对 TIA 和轻微中风的评估，当通过非散瞳眼底摄影增强时，可以提高诊断能力，并在需要额外专业知识时提供远程医疗咨询的潜力。