Modifiable Determinants of Ventricular Arrythmias

室性心律失常的可改变决定因素

• 批准号: 7267925
• 负责人: CHRISTINE M ALBERT
• 金额: $ 12.23万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-08-01 至 2009-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7267925
• 关键词: Acute; Adrenergic beta-Antagonists; Alcohol consumption; Alcohols; Anger; Angiotensin-Converting Enzyme Inhibitors; Anxiety; Cardiac; Characteristics; Chronic; Clinical; Clinical Management; Clinical Trials; Cohort Studies; Collection; Coronary Arteriosclerosis; Cox Proportional Hazards Models; Data; Development; Devices; Enrollment; Exploratory/Developmental Grant; Fire - disasters; Functional disorder; General Population; Gills; Goals; Habits; Heart Arrest; Implantable Defibrillators; Incidence; Intervention; Knowledge; Left; Life; Life Style; Modality; Moderate Exercise; Pain; Patients; Pharmaceutical Preparations; Physical activity; Population; Population Study; Populations at Risk; Predisposition; Prevention; Prevention strategy; Prevention therapy; Preventive; Proportional Hazards Models; Psychosocial Factor; Public Health; Quality of life; Rate; Recording of previous events; Recurrence; Research; Research Personnel; Risk; Risk Factors; Shock; Smoke; Smoking; Tachycardia; Time; United States; Validation; Ventricular; Ventricular Arrhythmia; Ventricular Fibrillation; Ventricular Tachycardia; cohort; cost; design; human data; insight; modifiable risk; mortality; programs; prospective; psychosocial; response; sudden cardiac death; trend

DESCRIPTION (provided by applicant): Since ventricular tachycardia (VT) and/or ventricular fibrillation (VF) underlie approximately 80% of the 400,000 SCDs that occur in the United states annually, the identification of risk factors for VT/VF is of public health importance. We are submitting this application in response to PA-03-015, which uses the R21 mechanism. This program requires the utilization of existing human data, does not require preliminary results, and limits the Research Plan to only 10 pages. In this application, we propose to utilize existing data assembled during the Triggers of Ventricular Arrhythmias (TOVA) study to identify predictors of ventricular arrhythmias in a population known to be at high risk. TOVA is a multi-center prospective cohort study that enrolled 1188 ICD patients at 31 centers in the United States and was designed to identify triggers of VT/VF among susceptible patients. The extensive information collected on clinical characteristics, lifestyle habits, psychosocial factors, and medications along with the collection and validation of electrograms from 500 instances of ICD firings over the course of the study provides a unique opportunity to examine the impact of lifestyle factors and medications on subsequent shocks for life-threatening ventricular arrhythmias. Specific hypotheses that will be examined in this population include the impact of psychosocial factors such as anger and anxiety; lifestyle factors such as smoking, alcohol, and physical activity; and non-traditional antiarrhythmic medications such as statins and angiotensin converting enzyme inhibitors on the risk of VT/VF. Multivariable Cox proportional hazards models will be used to evaluate associations between exposures and time to first ICD discharge for a confirmed episode of VT/VF, and Anderson-Gill proportional hazards models will be used to incorporate recurrent ICD discharges. By identifying risk factors specific for VT/VF in this high risk population, new understanding regarding the pathophysiology of ventricular arrhythmias may be gained, which may aid in the development of new preventive modalities for ventricular arrhythmias and SCO in the general population as well as in high risk patients. As a secondary goal, the identification of potentially modifiable lifestyle habits and medications that may influence risk of painful ICD shocks may significantly impact the clinical management and the subsequent quality of life of ICD patients.

描述（由申请人提供）：由于室性心动过速（VT）和/或室颤（VF）是美国每年发生的400，000例SCD中约80%的基础，因此确定VT/VF的风险因素具有公共卫生重要性。我们提交此申请是为了响应PA-03-015，该申请使用R21机制。该计划需要利用现有的人类数据，不需要初步结果，并将研究计划限制在10页以内。在本申请中，我们建议利用室性心律失常触发（TOVA）研究期间收集的现有数据，以确定已知高风险人群中室性心律失常的预测因素。TOVA是一项多中心前瞻性队列研究，在美国31家中心入组了1188例ICD患者，旨在识别易感患者中VT/VF的触发因素。在研究过程中，收集了关于临床特征、生活习惯、心理社会因素和药物沿着的大量信息，并收集和验证了500例ICD击发的电描记图，这为研究生活方式因素和药物对危及生命的室性心律失常后续电击的影响提供了独特的机会。将在该人群中检查的具体假设包括社会心理因素（如愤怒和焦虑）、生活方式因素（如吸烟、饮酒和体力活动）以及非传统抗心律失常药物（如他汀类药物和血管紧张素转换酶抑制剂）对VT/VF风险的影响。多变量考克斯比例风险模型将用于评价暴露与确认的VT/VF发作的首次ICD放电时间之间的相关性，Anderson-Gill比例风险模型将用于纳入复发性ICD放电。通过确定高危人群中VT/VF的特定风险因素，可以获得关于室性心律失常病理生理学的新理解，这可能有助于开发普通人群以及高危患者中室性心律失常和SCO的新预防模式。作为次要目标，识别可能影响痛苦的ICD电击风险的潜在可改变的生活习惯和药物可能会显着影响ICD患者的临床管理和后续生活质量。