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Cardioembolism as a Mechanism of Central Retinal Artery Occlusion

心源性栓塞作为视网膜中央动脉闭塞的机制

基本信息

批准号：
10773701
负责人：
Brian Mac Grory
金额：
$ 5.32万
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：
2022-09-01 至 2024-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10773701
关键词：
Academic Medical Centers Acute Address Administrative Supplement Affect Age Anticoagulation Applied Research Area Atrial Fibrillation Attenuated Award Awareness Back Biological Markers Biometry Blood Vessels Blood coagulation Brain imaging Cardiac Cardiac Electrophysiologic Techniques Cardiology Carotid Atherosclerotic Disease Carotid Stenosis Central Retinal Artery Occlusion Cerebrovascular Disorders Cerebrum Clinic Clinical Investigator Clinical Research Coagulation Process Collaborations Comparative Effectiveness Research Cross-Sectional Studies Data Data Science Data Set Databases Death Rate Development Diagnosis Diagnostic Diameter Disease Electrocardiogram Embolism Etiology Eye Failure Fright Functional disorder Future Goals Heart Heart Atrium Heart Diseases Incidence Institution Internal Carotid Artery Stenosis Investigation Ipsilateral Ischemic Stroke K-Series Research Career Programs Left Life Link Medicare Medicine Mentored Patient-Oriented Research Career Development Award Mentors Mentorship Methodology Monitor Neurology Observation in research Observational Study Ophthalmology Output Parents Paternity Leave Pathogenesis Pathology Pathway interactions Patients Persons Pharmacy facility Physicians Physiological Play Population Prevention strategy Principal Investigator Publications Recurrence Research Research Design Research Personnel Retina Risk Risk Factors Role Sampling Scientist Secondary Prevention Sentinel Serum Societies Stenosis Stroke Structure Testing Therapeutic Embolization Thrombus Time Training Ultrasonography United States National Institutes of Health Ventricular Ventricular Dysfunction Visual Walking beneficiary cardiovascular risk factor career career development cohort comorbidity disability evidence base heart rhythm indexing insight multidisciplinary novel patient oriented patient subsets population based prevent prospective risk mitigation sex skills

项目摘要

ABSTRACT This is an application for an Administrative Supplement to Promote Research Continuity and Retention of NIH Mentored Career Development (K) Award recipients. The purpose is to provide the principal investigator, Dr. Brian Mac Grory, with the support necessary to maintain his research output during a period of paternity leave. Dr. Mac Grory is a vascular neurology investigator pursuing patient-oriented clinical research focused on the identification of novel populations with underexplored cerebrovascular disorders requiring personalized secondary prevention strategies. Based on compelling preliminary data and recent publications, the central hypothesis of this proposal is that central retinal artery occlusion (CRAO) – a form of ischemic stroke affecting the retina – may be an indicator of underlying cardiac disease and a sentinel of future, potentially lethal, cardioembolic stroke. CRAO is formally recognized as a form of ischemic stroke but there is an incomplete understanding of its mechanistic underpinnings, with most research to-date focused on its association with carotid artery stenosis. The parent K23 award proposes to generate key preliminary data linking CRAO with cardioembolic substrates and set the stage for a future, multi-center, observational study that will definitively test this hypothesis. Dr. Mac Grory will leverage a very large population-based dataset (the Medicare 5% Sample) as well as both retrospective and prospective institutional cohorts. Specific Aims 1A & 1B will determine the association of each of atrial fibrillation and left ventricular failure with the development of CRAO and comprise the focus of the current application for an Administrative Supplement. Specific Aims 2A & 2B will determine the association of cardiac, serum and ultrasonographic biomarkers of embolic risk with CRAO and their interplay with carotid artery stenosis. As part of this proposal, Dr. Mac Grory will undertake a linked, didactic training plan with the goal of developing as an independent investigator through acquisition of the following key skills: 1) Biostatistics in observational research including advanced causal inference methodology, 2) Data science applied to administrative claims databases, 3) Prospective, observational study design, and 4) Vascular biomarker interpretation. Advanced training in these areas will permit Dr. Mac Grory to realize his long-term career goal of becoming an independent clinical investigator who leverages interdisciplinary expertise to provide insights in to the management of understudied cerebrovascular disorders. In pursuit of this goal, Dr. Mac Grory has assembled a mentoring team with distinct though complementary skillsets in stroke medicine, comparative effectiveness research, causal inference methodology, cardiac electrophysiology, and neuro-ophthalmology. With the preliminary data and training obtained from the proposed research, Dr. Mac Grory will be uniquely equipped to execute future, larger-scale studies uncovering novel populations in whom evidence-based, potentially life-saving secondary prevention strategies may be deployed. The scientific goals and approach remain unchanged from the original proposal.

摘要这是一份行政副刊的申请，以促进NIH研究的连续性和保留性指导职业发展(K)奖获得者。其目的是为首席研究员Dr。在必要的支持下，他在陪产假期间保持了他的研究成果。 Mac Grory博士是一名血管神经学研究员，致力于以患者为导向的临床研究，重点是需要个体化的未充分探索的脑血管疾病新人群的识别二级预防策略。基于令人信服的初步数据和最近的出版物，中央银行这一建议的假设是视网膜中央动脉阻塞(CRAO)--一种形式的缺血性中风视网膜-可能是潜在心脏病的指示器，也是未来可能致命的哨兵，心源性中风。CRAO被正式确认为缺血性中风的一种形式，但有一种不完全的对其机制基础的理解，迄今大多数研究集中在其与颈动脉狭窄。父K23奖项建议生成关键的初步数据，将CRAO与并为未来的多中心观察性研究奠定了基础检验这一假设。Mac Grory博士将利用一个非常大的基于人口的数据集(Medicare 5% 样本)以及回顾和预期的机构队列。具体目标1A和1B将确定房颤和左心衰与CRAO发生的关系并构成目前申请行政补编的重点。具体目标2A和2B 将确定心脏、血清和超声生物标记物的血栓风险与CRAO的关系以及它们与颈动脉狭窄的相互作用。作为这项提案的一部分，Mac Grory博士将进行一项相关的教学培训计划，目标是通过收购以下关键技能：1)观察性研究中的生物统计学，包括高级因果推理方法论，2)数据科学应用于行政索赔数据库，3)前瞻性，观察性研究设计和4)血管生物标记物的解释。这些领域的高级培训将使Mac Grory博士能够实现他长期的职业目标，成为一名独立的临床研究员，利用跨学科的专业知识，为研究不足的脑血管疾病的管理提供洞察力。为了追求这一目标，麦克·格罗里博士组建了一个指导团队，他们虽然互为补充，但却截然不同中风医学、比较疗效研究、因果推理方法学、心脏电生理学和神经眼科。初步数据和从拟议的研究，Mac Grory博士将拥有独特的装备来执行未来更大规模的研究，揭示可能采取循证的、可能挽救生命的二级预防策略的新人群已部署。科学目标和方法与最初的提议保持不变。