Atrial fibrillation burden, vascular disease of the brain and cardiac MRI in MESA

MESA 中的心房颤动负担、脑部血管疾病和心脏 MRI

• 批准号: 9312865
• 负责人: SUSAN R HECKBERT
• 金额: $ 197.2万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-08-01 至 2019-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9312865
• 关键词: Age; Ambulatory Monitoring; Arrhythmia; Atrial Fibrillation; Biological Markers; Blood Pressure; Blood Vessels; Blood flow; Brain; Brain natriuretic peptide; Cardiac; Cardiovascular Diseases; Cardiovascular system; Caucasians; Cerebrovascular Disorders; Cerebrum; Cessation of life; Characteristics; Clinical; Clinical Research; Consent; Defibrillators; Dementia; Diabetes Mellitus; Disease; Elderly; Electrocardiogram; Embolism; Event; Fibrosis; Galectin 3; General Population; Heart Abnormalities; Heart Atrium; Heart Diseases; Heart failure; Height; Hypertension; Impaired cognition; Implant; Infarction; Ischemic Stroke; Knowledge; Left; Left Atrial Function; Left Ventricular Mass; Longitudinal Studies; Magnetic Resonance Imaging; Measures; Monitor; Multi-Ethnic Study of Atherosclerosis; Myocardial; Myocardial Infarction; N-terminal; Outcome; Pacemakers; Participant; Patients; Physical Function; Physicians; Population; Population Study; Prevalence; Public Health; Publishing; Recording of previous events; Recruitment Activity; Research; Research Personnel; Risk; Risk Factors; Sampling; Smoking History; Stress; Stroke; Structure; Symptoms; Time; Time Study; Ventricular; Ventricular Function; Weight; base; brain abnormalities; cardiovascular disorder prevention; clinical care; cognitive function; cohort; cost; design; experience; follow-up; functional loss; heart rhythm; high risk; implantable device; male; monitoring device; novel; novel marker; outcome prediction; public health relevance; sex; white matter

 DESCRIPTION (provided by applicant): Atrial fibrillation (AF), a common arrhythmia, is associated with substantially elevated risks of stroke, cognitive decline, dementia, arterial emboli, heart failure, and cardiovascular death. Existing studies of AF rely on clinical recognitio of AF when a patient presents with symptoms, but studies in patients with implanted monitoring devices such as pacemakers or defibrillators indicate that a large proportion of AF episodes produce no symptoms at all (subclinical AF). Therefore, relying on patient symptoms to identify AF seriously underestimates AF burden, defined as the proportion of monitored time that the cardiac rhythm is AF. Convenient new external ECG patch monitors now make possible extended ambulatory monitoring at reasonable cost, and permit identification of subclinical AF and estimation of AF burden. However, there is little information about the distribution or predictors of subclinical AF or AF burden; their associations with brain structure and function or with clinical cardiovascular events; or the association of left atrial or ventricular function or structure with subclinical AF and AF burden. What little evidence is available from studies in patients with implanted devices suggests that AF complications occur whether or not patients are experiencing symptoms with their AF. We propose to conduct a study of AF and AF burden in relation to cerebral and cardiac structure and function and cardiovascular events in the Multi-Ethnic Study of Atherosclerosis (MESA). We will recruit a total of 1500 MESA participants from all 6 Field Centers using a cohort design: 1) 300 participants with clinically-recognized AF during previous MESA follow-up; 2) 450 participants at high risk for AF based on NT-proBNP level drawn in 2010-2012 and a published AF risk score, and 3) a random sample of 750 participants. The 1500 participants will have two 14-day ECG monitoring episodes in 2016-2017, and consenting participants (estimated n=1350) will have a brain MRI one to two years later. We will examine the presence of AF and AF burden from the ambulatory ECG monitoring in relation to measures from the brain MRI done one to two years after ECG monitoring, and in relation to cardiovascular events during MESA events follow-up. We will also examine measures from the 2010-2012 cardiac MRI, as well as participant characteristics and biomarkers, in relation to the presence of AF and AF burden on the monitor. Information from our study will help physicians and researchers decide on the utility of measuring subclinical AF and AF burden as new ways of quantifying AF. Knowledge about cardiac and brain abnormalities and cardiovascular events associated with the spectrum of AF burden may have implications for clinical care, including decisions about therapy to reduce the risk of stroke and heart failure and whether follow-up monitoring is warranted for patients who have had a single first episode of AF.

 描述（由申请人提供）：房颤（AF）是一种常见的心律失常，与卒中、认知能力下降、痴呆、动脉栓塞、心力衰竭和心血管死亡的风险显著升高相关。现有的AF研究依赖于患者出现症状时的AF临床诊断，但对植入起搏器或除颤器等监测设备的患者的研究表明，大部分AF发作根本不产生症状（亚临床AF）。因此，依靠患者症状来识别AF严重低估了AF负担，AF负担定义为心律为AF的监测时间比例。方便的新型外部ECG贴片监测器现在可以以合理的成本进行扩展的动态监测，并允许识别亚临床AF和估计AF负担。然而，关于亚临床AF或AF负荷的分布或预测因素;其与脑结构和功能或与临床心血管事件的相关性;或左心房或心室功能或结构与亚临床AF和AF负荷的相关性的信息很少。从植入器械患者的研究中获得的证据很少，表明无论患者是否出现AF症状，都会发生AF并发症。我们建议在多种族动脉粥样硬化研究（梅萨）中进行AF和AF负荷与大脑和心脏结构和功能以及心血管事件相关的研究。我们将使用队列设计从所有6个现场中心招募总计1500名梅萨参与者：1）300名临床确认为AF的参与者， 梅萨后续行动; 2）基于2010-2012年得出的NT-proBNP水平和已发表的AF风险评分，450名AF高风险参与者，以及3）750名参与者的随机样本。1500名参与者将在2016-2017年进行两次为期14天的ECG监测，知情同意的参与者（估计n=1350）将在1 - 2年后进行脑部MRI。我们将检查是否存在AF和AF负荷，从动态ECG监测到与ECG监测后1 - 2年进行的脑MRI测量相关，以及与梅萨事件随访期间的心血管事件相关。我们还将检查2010-2012年心脏MRI的指标，以及参与者特征和生物标志物，与监测器上AF和AF负担的存在相关。我们研究的信息将帮助医生和研究人员决定将测量亚临床AF和AF负担作为量化AF的新方法的实用性。有关心脏和大脑异常以及与AF负担谱相关的心血管事件的知识可能对临床护理有影响，包括关于降低中风和心力衰竭风险的治疗的决定，以及是否遵循-对于有过一次首次房颤发作的患者，有必要进行监测。