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Epidemiologic Determinants of Cardiac Structure and Function in Rural Residents: RURAL ECHO

农村居民心脏结构和功能的流行病学决定因素：RURAL ECHO

基本信息

批准号：
10852586
负责人：
Gerald Samuel Bloomfield
金额：
$ 57.79万
依托单位：
DUKE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-02-21 至 2025-12-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10852586
关键词：
Administrative Supplement Adult American Anatomy Ancillary Study Appalachian Region Area Artificial Intelligence Atrial Function Biochemistry Biological Biological Factors Biological Markers Black Populations Body mass index Brain natriuretic peptide Cardiac Cardiovascular Diseases Cardiovascular system Clinic Clinical Clinical Data Cohort Studies Collaborations Color County Data Data Set Demography Dimensions Disease Echocardiography Epidemiologic Factors Epidemiology Ethnic Population Excess Mortality Female Funding General Population Geography Goals Health Heart Abnormalities Heart Atrium Heart Valve Diseases Heart failure High Prevalence Image Individual Individual Differences Infrastructure Intervention Knowledge Laboratories Life Link Longitudinal Studies Longitudinal cohort Longitudinal cohort study Methodology Mission Mississippi Mitral Valve Morbidity - disease rate Morphology Multimodal Imaging Myocardial Infarction N-terminal National Heart, Lung, and Blood Institute Obesity Outcome Parents Participant Pathology Phenotype Population Population Heterogeneity Population Study Predisposition Prevalence Prognosis Proteins Ptosis Public Health Race Reduce health disparities Reporting Research Resources Risk Risk Assessment Risk Factors Rural Rural Appalachia Rural Population Scientific Inquiry Serum Severities Severity of illness Somatotype Stroke Structure Symptoms Techniques Testing Thinness Time Troponin United States National Institutes of Health Variant Ventricular Vermont Work burden of illness calcification cardiovascular disorder risk cardiovascular risk factor circulating biomarkers comorbidity cost effective health determinants health equity heart damage high risk high risk population imaging biomarker improved innovation mortality novel population based population stratification prospective risk mitigation risk stratification rural America rural area rural dwellers rural residence rural underserved screening social factors social health determinants tool

项目摘要

ABSTRACT Rural dwelling adults in the US South suffer disproportionate cardiovascular disease (CVD) burden and mortality. The Appalachia and Mississippi Delta (AMD) regions are particularly at risk, embedded in the stroke, heart attack and heart failure (HF) mortality belts, where the determinants are multifactorial. Echocardiography is an ideal methodology to study CVD and determine high risk imaging phenotypes for incident heart failure owing to its ability to noninvasively assess cardiac structure and function simultaneously. Due to the excess of CVD in the AMD region, we therefore expect a high prevalence of abnormal cardiac structure and function among rural adults, but this has not been explicitly shown. The NHLBI-funded Risk Underlying Rural Areas Longitudinal (RURAL) cohort study, by assessing a broad array of phenotypic, biologic, and social determinants of health represents a unique, cost-effective opportunity to implement a study to fill the gaps described, reduce excess CVD burden, and achieve health equity for all Americans. The long-term goal of this proposal is to understand the burden of adverse cardiac remodeling in the absence of symptoms (i.e., Stage B HF) in the AMD region and factors contributing to it so that interventions during subclinical disease states may avert clinical HF later in life. The overall objectives of this application are to apply in-depth echocardiographic phenotyping to the entire RURAL cohort and combine these echo data with the broad array of data acquired in RURAL to identify those factors which selectively amplify or mitigate HF risk. Using the infrastructure of the parent study’s mobile examination unit (MEU) – ‘a clinic on wheels’ – we will perform echocardiography on all participants at baseline to characterize cardiac structure and function using a novel artificial-intelligence (AI) echo approach. Our central hypothesis is that there is a significant burden of Stage B HF, which is associated with exposures spanning multiple domains and which can be delineated by integrating the multimodality imaging on the MEU. We will achieve our objectives through these specific aims: (Aim 1) Use AI Echo and meticulous core lab analysis to extensively characterize cardiac structure and function in RURAL; (Aim 2) Determine associations of AI Echo findings with traditional biologic risk factors and comorbidities, with an exploratory sub-Aim to determine associations between Stage B HF and social determinants of health; and (Aim 3) To interrogate mechanisms of Stage B HF by determining relationships between echo-based imaging biomarkers, CV calcifications, adiposity and CV risk. The proposed study will provide the largest and most comprehensive echocardiographic dataset focused on rural adults that untangles the relative importance of the association between biologic and social factors on Stage B HF and incorporates advanced methodology to discover sub-phenotypes of Stage B HF based on multimodality imaging. RURAL Echo promises to yield new knowledge on rural CV health that is highly relevant to individual and US public health.

摘要