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

• 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
• 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

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 美国南部的农村成年人患有不成比例的心血管疾病(CVD)负担， 死亡率。阿巴拉契亚和密西西比三角洲(AMD)地区尤其危险，嵌入中风， 心脏病发作和心力衰竭(HF)死亡带，其中决定因素是多因素的。超声心动图 是研究心血管疾病和确定心力衰竭高危影像表型的理想方法 由于它能够同时无创地评估心脏结构和功能。由于过量的 在AMD地区的心血管疾病，因此我们预计心脏结构和功能异常的发生率很高 在农村成年人中，但这一点还没有明确显示出来。农村基础设施建设融资风险研究 纵向(农村)队列研究，通过评估广泛的表型、生物学和社会性 健康的决定因素是一个独特的、具有成本效益的机会，可以实施一项填补空白的研究 描述，减少过度的心血管疾病负担，实现所有美国人的健康公平。这样做的长期目标是 建议理解在没有症状的情况下(即B阶段)心脏不良重塑的负担 在AMD地区)以及导致它的因素，以便在亚临床疾病状态期间的干预可以 在以后的生活中避免临床心力衰竭。此应用程序的总体目标是应用深度超声心动图 对整个农村队列进行表型分析，并将这些回波数据与在 农村，以确定那些有选择地放大或减轻心力衰竭风险的因素。使用的基础设施 Parent Study的流动检查单元(MEU)--“车轮上的诊所”--我们将对所有患者进行超声心动图检查 参与者在基线上使用一种新的人工智能(AI)来表征心脏结构和功能 回声进场。我们的中心假设是B期心力衰竭有很大的负担，这与 具有跨越多个域的曝光，并且可以通过集成多模式来描绘 在MEU上进行成像。我们将通过这些具体目标实现我们的目标：(目标1)使用AI Echo和 细致的核心实验室分析，以广泛描述农村心脏结构和功能；(目标2) 确定AI Echo结果与传统生物风险因素和共病的关联，以及 探索性次目标是确定B期心力衰竭与健康的社会决定因素之间的联系；以及 (目标3)通过确定基于回声的成像之间的关系来询问B期心衰的机制 生物标记物、心血管钙化、肥胖和心血管风险。拟议的研究将提供最大和最多的 关注农村成年人的综合超声心动图数据集，揭示了 B期心力衰竭的生物和社会因素之间的联系，并结合先进的方法学 基于多模式成像发现B期心衰的亚型。农村回声承诺产生新的 与个人和美国公共卫生高度相关的农村个人健康知识。