Assessing Population-based Radiological brain health in Stroke Epidemiology (APRISE) Study

评估中风流行病学中基于人群的放射学脑健康 (APRISE) 研究

• 批准号: 9975234
• 负责人: BRETT M KISSELA
• 金额: $ 63.37万
• 依托单位: UNIVERSITY OF CINCINNATI
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-30 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9975234
• 关键词: Acute; Address; Ancillary Study; Area; Automobile Driving; Biometry; Blood Vessels; Brain hemorrhage; Carotid Stenosis; Cause of Death; Cerebrovascular Disorders; Cerebrum; Clinical; Collection; Data; Disease; Educational Intervention; Epidemiology; Event; Family; Funding; Future; Genetic; Goals; Guidelines; Image; Incidence; Individual; Infrastructure; Investigation; Ischemia; Ischemic Stroke; Kentucky; Lacunar Infarctions; Magnetic Resonance Imaging; Measures; Microvascular Dysfunction; Minor; Modeling; Modernization; Morbidity - disease rate; National Institute of Neurological Disorders and Stroke; Outcome; Pathway interactions; Patients; Population; Population Heterogeneity; Positioning Attribute; Predisposition; Prevalence; Public Health; Radiologic Finding; Radiology Specialty; Recording of previous events; Recurrence; Research Priority; Risk; Risk Factors; Role; Severities; Source; Stroke; Surveys; Time; Tissues; United States National Institutes of Health; Vascular Dementia; White Matter Hyperintensity; Work; base; biracial; brain health; career; cerebral atrophy; cerebrovascular; clinical care; clinical decision-making; clinical investigation; cohort; disability; epidemiology study; high risk; imaging biomarker; improved; innovation; mortality; multidisciplinary; novel; parent grant; population based; predictive modeling; racial disparity; racial diversity; spectrograph; stroke event; stroke patient; stroke risk; tool

DESCRIPTION/ABSTRACT: Stroke recurrence is a major public health problem. It has been understudied epidemiologically despite comprising ~25% of all stroke in the US, and leading to higher morbidity and mortality compared to initial events. Furthermore, compared to our understanding of the role of traditional risk factors for first stroke, we have limited understanding of the risk factors for recurrent stroke. Radiological measures of small vessel and large-vessel disease may provide a measure of a subject’s current “Brain Health” to predict future cerebrovascular events and vascular dementia. Understanding small vessel disease in particular—manifesting as white matter hyperintensity, microbleeds, lacunar infarcts, dilated perivascular spaces, and brain atrophy–is a top NINDS priority. Although the Framingham risk score is widely used for clinical decision-making, and the ABCD scores predict 90-day stroke risk among minor stroke/TIA patients, no clinical prediction tool in a broader ischemic or a hemorrhagic stroke population-based cohort has been established. A Framingham-like “Risk Function Tool for Secondary Stroke,” especially one incorporating the full gamut of modern imaging parameters developed in a racially diverse population, would likely identify high-risk patients for targeted education interventions, novel antithrombotics, and aggressive clinical care. Moreover, it may reveal novel causal pathways and risk factors for future investigation. We propose an ancillary study to the ongoing Greater Cincinnati/Northern Kentucky Stroke Study (GCKNSS) entitled APRISE (Assessing Population-based Radiological brain health in Stroke Epidemiology). Our objective is to build on the GCNKSS infrastructure to radiologically characterize the full stroke/TIA population of Greater Cincinnati/Northern Kentucky from 2015 and create the first modern, largely MRI-based characterization of brain health in a contemporary stroke/TIA population. Our specific aim is to create a prediction model of cerebrovascular disease recurrence (ischemic or hemorrhagic stroke) incorporating imaging parameters in a biracial, large-scale ischemic stroke/TIA population using state-of-the-art modeling approaches. We will achieve these goals by radiologically characterizing the stroke/TIA population (~2700 ischemic and ~525 hemorrhagic stroke, and ~1025 TIA patients) in the NIH-funded GCNKSS of a 1.4 million, biracial population. We will leverage the extensive GCNKSS infrastructure, which is already in place to detect recurrent stroke, placing us in a unique position to develop a recurrent stroke risk model using newly acquired radiologic data with remarkable efficiency. The proposed study will allow the first and only population-based characterization of the entire imaging spectrum of brain health in stroke/TIA patients. Our multi-disciplinary team with imaging, epidemiology, outcomes, and biostatistics expertise will address NINDS priority research areas with precision and innovation currently unavailable.

说明/摘要： 中风复发是一个主要的公共卫生问题。尽管在流行病学上对它的研究还不够充分 约占美国所有中风的25%，与最初的中风相比，导致更高的发病率和死亡率 事件。此外，与我们对传统风险因素在首次中风中的作用的理解相比，我们 对卒中复发的危险因素了解有限。小血管和小血管的放射措施 大血管疾病可能为受试者目前的“大脑健康”提供一种衡量标准，以预测未来 脑血管事件和血管性痴呆。了解小血管疾病的具体表现 如白质高信号、微量出血、腔隙梗死、血管周围间隙扩张和脑萎缩-是 NINDS的首要任务。尽管Framingham风险评分被广泛用于临床决策，而且 ABCD评分可预测轻度中风/短暂性脑缺血发作患者90天的中风风险，在 已经建立了更广泛的基于人群的缺血性或出血性卒中队列。一个像弗雷明翰一样的 “二次卒中的风险函数工具”，尤其是结合了现代成像的全色域的工具 在不同种族人群中开发的参数，可能会确定目标人群中的高危患者 教育干预、新型抗血栓药物和积极的临床护理。此外，它还可能揭示出小说 致病途径和危险因素为今后的调查。我们建议对正在进行的更大规模的 辛辛那提/北肯塔基州中风研究(GCKNSS)，题为APRISE(基于人群的评估 卒中流行病学中的放射学脑健康)。我们的目标是在GCNKSS基础设施的基础上 2015年大辛辛那提/北肯塔基州全卒中/短暂性脑缺血发作人群的放射学特征 并创造了第一个现代的，主要基于MRI的现代中风/短暂性脑缺血发作的脑健康特征 人口。我们的具体目标是建立一个脑血管疾病复发的预测模型 (缺血性或出血性卒中)合并影像参数的双侧大范围脑缺血 中风/短暂性脑缺血发作人群使用最先进的建模方法。我们将通过以下方式实现这些目标 卒中/短暂性脑缺血发作人群的放射学特征(约2700例缺血性中风和约525例出血性中风，以及 约1025名TIA患者)在NIH资助的140万混血人口的GCNKSS中。我们将利用 广泛的GCNKSS基础设施，它已经到位，可以检测复发的中风，使我们处于一个独特的 使用新获得的具有显著差异的放射学数据来开发复发中风风险模型的位置 效率。拟议的研究将第一次也是唯一一次以人口为基础描述整个 卒中/短暂性脑缺血发作患者脑健康的影像频谱。我们的多学科团队拥有成像技术， 流行病学、结果和生物统计学专业知识将精确地解决NINDS的优先研究领域 而创新目前还不可用。