Frailty, Aging, and Risk of Adverse Outcomes in Mitral Valve Prolapse (FAR-OUT-MVP Study)

二尖瓣脱垂的虚弱、衰老和不良后果风险（FAR-OUT-MVP 研究）

• 批准号: 10836297
• 负责人: Jordan Blair Strom
• 金额: $ 17.28万
• 依托单位: BETH ISRAEL DEACONESS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10836297
• 关键词: Accident and Emergency department; Adverse event; Age; Aging; Arrhythmia; Atrial Fibrillation; Attenuated; Benign; Blood flow; Cardiac; Cardiovascular system; Case Mixes; Communities; Data; Data Linkages; Data Set; Data Sources; Databases; Decision Making; Development; Disease; Echocardiography; Employee; Endocarditis; Enrollment; Event; Fibrosis; Future; General Population; Heart Valve Diseases; Heart failure; Heterogeneity; Homeostasis; Image; Impairment; Implantable Defibrillators; Individual; Inpatients; Institution; Insurance; Investigation; Israel; Left; Link; Magnetic Resonance; Massachusetts; Medical center; Mitral Valve; Mitral Valve Insufficiency; Mitral Valve Prolapse; Morbidity - disease rate; Myocardial; Myocardial Contraction; National Heart, Lung, and Blood Institute; Natural History; Outcome; Outpatients; Patients; Phenotype; Physiological; Population; Prevalence; Privatization; Prognosis; Provider; Registries; Reporting; Risk; Risk Factors; Role; Rupture; Secondary to; Severities; Stressful Event; Stretching; Structure; Survivors; System; Tissues; Ventricular; Ventricular Arrhythmia; Vulnerable Populations; adverse event risk; adverse outcome; aortic valve disorder; cardiac magnetic resonance imaging; cardiovascular risk factor; cerebrovascular; clinically relevant; cohort; frailty; heart imaging; high risk; human old age (65+); imaging biomarker; improved; insight; mitral valve replacement; mortality; mortality risk; novel; papillary muscle; repaired; stressor; structured data; sudden cardiac death

PROJECT SUMMARY Mitral valve prolapse (MVP) is a common cardiac valvular disease, with a prevalence of roughly 2-3% in the general population, associated with excess mitral valve or chordal tissue may predispose to the development of mitral regurgitation (MR) from leaflet malcoaptation and chordal rupture. This condition and its sequelae, detected on echocardiograms (TTEs) and cardiac magnetic resonance images (CMRs), has been previously felt to be associated with an overall benign prognosis. Recent evidence suggest a subset of individuals with MVP have an excess risk of cardiovascular and non-cardiovascular morbidity and mortality, including ventricular arrhythmias and sudden cardiac death. Despite known risks of MVP, it remains challenging to identify high risk subsets in need of further treatments such as implantable defibrillator use or mitral valve repair or replacement. Furthermore, disaggregating the risk of MVP from that of concomitant MR remains challenging at present. Moreover, while individual imaging biomarkers of risk have been identified, which of these independently influence MVP risk when considered together remains unclear. While relevant clinical risk factors including aging and frailty, “a state of increased vulnerability and reduced ability to maintain homeostasis after a stressful event resulting from an impairment in multiple physiologic systems,” have found to influence outcome risk in other valvular heart diseases, it remains unclear if aging and frailty modify the risk of MVP on adverse outcomes. This proposal leverages the unique linkage of two large data sources, structured datasets of TTE and CMR reports from Beth Israel Deaconess Medical Center, and all-payer statewide claims data from the Massachusetts Case Mix Dataset (MACM) to better evaluate the risk of MVP across the spectrum of age and frailty. In this study, we propose to directly link BIDMC TTE and CMR reports to MACM data to evaluate whether MVP is associated with a risk of mortality, cardiovascular morbidity (composite of heart failure, atrial fibrillation, cerebrovascular event, endocarditis), and need for mitral valve replacement or repair, and whether this risk relationship varies by age and frailty as well as operative status (receipt of mitral valve replacement or repair). Doing so, this study will provide greater insight into the role that aging and frailty may have on the risk of serious outcomes associated with MVP and build a unique registry of cardiac imaging information linked to outcome data that could be leveraged in the future to deepen understanding of MVP as well as other valvular heart diseases.

项目摘要 二尖瓣脱垂（MVP）是一种常见的心脏瓣膜疾病，患病率约为2-3％ 与二尖瓣或弦组织过多有关的一般人群可能会易于发育 丝线反性（MR）的传单不良和弦破裂。这种情况及其后遗症， 在超声心动图（TTE）和心脏磁共振图像（CMR）上检测到 感觉与整体良性预后有关。最近的证据表明，有一部分 MVP的心血管和非心血管发病率和死亡率的风险过多，包括 心室心律不齐和心脏猝死。尽管已知的MVP风险，但仍有挑战 确定需要进一步治疗的高风险子集，例如植入式除颤器或二尖瓣 阀门维修或更换。此外，将MVP与伴随MR的风险分解 目前仍然是挑战。此外，虽然已经确定了风险的单个成像生物标志物，但 当考虑在一起时，这些独立影响MVP风险仍不清楚。虽然相关 临床危险因素，包括衰老和脆弱，“脆弱性增加和维持能力降低的状态 在多种生理系统损害的压力事件发生后，体内平衡，” 为了影响其他瓣膜心脏病的结果风险，尚不清楚衰老和脆弱是否会改变风险 MVP的下降结果。该建议利用了两个大数据源的独特联系， 来自贝丝以色列执事医疗中心的TTE和CMR报告的结构化数据集和所有付款人 全州索赔来自马萨诸塞州案例混合数据集（MACM）的数据，以更好地评估MVP的风险 跨越年龄和脆弱的范围。在这项研究中，我们建议直接连接BIDMC TTE和CMR报告 到MACM数据以评估MVP是否与死亡率，心血管发病率有关 （心力衰竭的复合，心房颤动，脑血管事件，心内膜炎）和二尖瓣的需求 替换或维修，以及这种风险关系是否随着年龄和脆弱和运营状态而变化 （接收二尖瓣更换或维修）。这样做，这项研究将为您提供更深入的了解 衰老和脆弱的角色可能会冒着与MVP相关的严重结果的风险并建立 与结果数据相关的心脏成像信息的独特注册表，可以在 深化对MVP以及其他瓣膜心脏病的未来。

项目成果

Moderate aortic stenosis: culprit or bystander?

• DOI: 10.1136/openhrt-2021-001743
• 发表时间: 2022-01
• 期刊: Open heart
• 影响因子: 2.7
• 作者: Pankayatselvan V;Raber I;Playford D;Stewart S;Strange G;Strom JB
• 通讯作者: Strom JB

Echocardiographic Progression of Peak Tricuspid Regurgitant Velocity Among Medicare Beneficiaries.

医疗保险受益人三尖瓣反流峰值速度的超声心动图进展。

• DOI: 10.1016/j.jacadv.2023.100579
• 发表时间: 2023
• 期刊: JACC. Advances
• 作者: Kholdani,CyrusA;Choudhary,Gaurav;Furfaro,DavidM;Markson,LawrenceJ;Manning,WarrenJ;Strom,JordanB
• 通讯作者: Strom,JordanB

The Association of Weekly Sonographer Feedback and Reduction in Sonographer Errors.

• DOI: 10.1016/j.echo.2021.08.011
• 发表时间: 2021-11
• 期刊: Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography
• 作者: Fostello SE;Stout JL;Manning WJ;Strom JB
• 通讯作者: Strom JB

Retrospective evaluation of echocardiographic variables for prediction of heart failure hospitalization in heart failure with preserved versus reduced ejection fraction: A single center experience.

• DOI: 10.1371/journal.pone.0244379
• 发表时间: 2020
• 期刊: PloS one
• 影响因子: 3.7
• 作者: Hammond MM;Shen C;Li S;Kazi DS;Sabe MA;Garan AR;Markson LJ;Manning WJ;Klein AL;Nagueh SF;Strom JB
• 通讯作者: Strom JB

Race, sex and age disparities in echocardiography among Medicare beneficiaries in an integrated healthcare system.

• DOI: 10.1136/heartjnl-2021-319951
• 发表时间: 2022-05-25
• 期刊: HEART
• 影响因子: 5.7
• 作者: Hyland, Patrick M.;Xu, Jiaman;Shen, Changyu;Markson, Lawrence J.;Manning, Warren J.;Strom, Jordan B.
• 通讯作者: Strom, Jordan B.