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 美国南部的农村居民成年人遭受不成比例的心血管疾病（CVD）负担， mortality.阿巴拉契亚和密西西比三角洲（AMD）地区的风险特别高，嵌入在中风， 心脏病发作和心力衰竭（HF）死亡带，其中的决定因素是多因素的。超声心动 是研究心血管疾病和确定心衰高危影像表型的理想方法 这是因为它能够同时无创地评估心脏结构和功能。由于过量的 因此，我们预期AMD地区的心血管疾病患病率较高，心脏结构和功能异常 在农村成年人中，这一点尚未明确显示。NHLBI资助的农村地区潜在风险 纵向（农村）队列研究，通过评估一系列广泛的表型，生物学和社会 健康的决定因素是一个独特的，具有成本效益的机会，实施一项研究，以填补空白， 如前所述，减少过度的CVD负担，实现所有美国人的健康公平。长期目标是 建议是理解在没有症状的情况下不利的心脏重塑的负担（即，阶段B HF）及其促成因素，以便在亚临床疾病状态期间进行干预， 避免日后出现临床HF。本申请的总体目标是应用深度超声心动图 表型分析整个农村队列，并将这些超声心动图数据联合收割机与 RURAL旨在确定选择性放大或减轻HF风险的因素。使用基础设施的 母研究的移动的检查单元（MEU）-“车轮上的诊所”-我们将对所有患者进行超声心动图检查。 基线参与者使用新型人工智能（AI）表征心脏结构和功能 回声进场我们的中心假设是，存在显著的B期HF负担，这与 具有跨越多个领域的暴露，并且可以通过整合多模态 在MEU上成像。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， 细致的核心实验室分析，以广泛表征农村患者的心脏结构和功能;（目标2） 确定AI Echo结果与传统生物风险因素和合并症的相关性， 探索性子目标，以确定B期HF与健康的社会决定因素之间的关联;以及 (Aim 3）通过确定基于回波的成像和基于回波的成像之间的关系来询问B期HF的机制。 生物标志物、CV钙化、肥胖和CV风险。这项研究将提供最大和最 一个全面的超声心动图数据集集中在农村成年人，解开的相对重要性， B期HF的生物和社会因素之间的关联，并结合先进的方法， 基于多模态成像发现B期HF的亚表型。农村回声承诺产生新的 农村CV健康知识与个人和美国公共卫生高度相关。