Left Atrial abNormality, ThromboEmbolism, and Race: Novel risk factors for stroke (LANTERN)

左心房异常、血栓栓塞和种族：中风的新危险因素 (LANTERN)

• 批准号: 9270634
• 负责人: Hooman Kamel
• 金额: $ 41.7万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-06-01 至 2020-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9270634
• 关键词: Address; Admission activity; African American; Ancillary Study; Anticoagulants; Atrial Fibrillation; Biology; Blood coagulation; Body Surface Area; Body mass index; Brain; Cardiac; Clinical; Data; Demographic Factors; Dilatation - action; Disease; Echocardiography; Electrocardiogram; Etiology; Face; Fibrosis; Fostering; Future; Heart; Heart Atrium; High Prevalence; Hypertrophy; Image; Incidence; Individual; Ischemic Stroke; Kentucky; Lead; Left; Left atrial structure; Light; Link; Longitudinal cohort study; Measurement; Measures; Mediating; Mission; Modeling; National Institute of Neurological Disorders and Stroke; Oral; Outcome; Pathogenesis; Patients; Pharmaceutical Preparations; Play; Population; Prevalence; Public Health; Race; Reporting; Research; Risk; Risk Factors; Risk Marker; Role; Source; Stroke; Stroke prevention; Testing; Therapeutic Embolization; Therapeutic Intervention; Thromboembolism; Time; Tissues; Visit; Work; biracial; black/white disparity; design; epidemiology study; experience; geographic difference; heart rhythm; high risk; improved; nervous system disorder; novel; population based; racial difference; racial disparity; screening

PROJECT SUMMARY/ABSTRACT African Americans face a two-fold higher risk of ischemic stroke than white residents of the U.S. The reasons for this black-white stroke disparity are not completely known. This proposal seeks to identify whether atrial cardiopathy, a novel risk factor, partly explains the higher stroke risk in blacks. Compared to whites, blacks experience less atrial fibrillation, a heart-rhythm disorder that is one of the strongest known risk factors for stroke. In the prevailing clinical paradigm, it is thought that atrial fibrillation is required for blood clots to form in the heart's left atrium, from where they can embolize to the brain and cause stroke. However, recent research indicates that embolization from the left atrium can occur when there are abnormalities in atrial tissue and function—a condition referred to as atrial cardiopathy—regardless of whether there is atrial fibrillation. Preliminary data suggest that atrial cardiopathy manifests differently in blacks than whites: more often with left atrial abnormality on a 12-lead electrocardiogram (ECG) and less often with atrial fibrillation or its typical accompaniment, left atrial enlargement on an echocardiogram. As a result, atrial thromboembolism may often go unrecognized in blacks because it occurs in the absence of atrial fibrillation and atrial enlargement. The proposed research will test the central hypothesis that currently unexplained disparities in stroke between whites and blacks can be partly explained by differences in the manifestation of atrial cardiopathy. This application is for an ancillary study to the REasons for Geographic and Racial Differences in Stroke (REGARDS) study and the Greater Cincinnati/Northern Kentucky Stroke Study (GCNKSS). REGARDS is a longitudinal cohort study that seeks to shed light on the relationship between baseline risk factors and future stroke in >30,000 black and white individuals. GCNKSS is a population-based epidemiological study of racial disparities in the incidence and outcomes of stroke in a biracial population of 1.3 million. Taking advantage of the complementary designs of these studies, the proposed research will first determine the relationship between baseline ECG-defined left atrial abnormality, race, and future stroke in REGARDS. It will then determine black-white differences in GCNKSS in markers that signify a potential atrial thromboembolic cause of stroke. Specific Aim 1 will test the hypotheses that blacks have a higher prevalence of left atrial abnormality, that left atrial abnormality is associated with future stroke, and that left atrial abnormality contributes to the higher stroke risk in blacks. Specific Aim 2 will test the hypotheses that black patients with ischemic stroke more often have ECG-defined left atrial abnormality and less often have echocardiographic left atrial enlargement than whites. All ECGs and a subset of echocardiogram images will be centrally interpreted. This research promises to show that blacks' higher stroke risk partly reflects actionable differences in the biology of stroke. Such findings may ultimately lead to therapy using existing medications approved for atrial fibrillation.

项目摘要/摘要 非洲裔美国人患缺血性中风的风险是美国白人居民的两倍 造成这种黑白中风差异的原因尚不完全清楚。这项提案旨在确定是否 房性心脏病是一种新的危险因素，它在一定程度上解释了黑人中风风险较高的原因。与白人相比， 黑人较少经历房颤，这是一种心律紊乱，是已知的最强烈的风险因素之一 治疗中风。在流行的临床模式中，认为心房颤动是形成血栓的必要条件。 在心脏的左心房，它们可以从那里栓塞到大脑并导致中风。然而，最近 研究表明，当心房组织出现异常时，可以从左心房进行栓塞。 和功能--一种称为房性心脏病的情况--无论是否存在房颤。 初步数据显示，房性心脏病在黑人和白人中的表现不同：更常见的是左房 12导联心电图上的心房异常，较少合并心房颤动或其典型的 伴随，超声心动图左房增大。因此，心房血栓栓塞症可能经常 在黑人中不被识别，因为它发生在没有心房颤动和心房扩大的情况下。这个 拟议中的研究将检验这一中心假设，即目前无法解释的中风差异 白人和黑人的部分原因可以解释为房性心脏病表现的差异。这 申请作为卒中地理和种族差异原因的辅助研究 (关于)研究和大辛辛那提/北肯塔基州中风研究(GCNKSS)。问候是一种 寻求阐明基线风险因素与未来之间关系的纵向队列研究 在&gt；30,000个黑人和白人中划线。GCNKSS是一项以人群为基础的种族流行病学研究 在130万混血人口中，中风发病率和预后的差异。利用 这些研究的互补性设计，建议的研究将首先确定两者的关系 基线心电图定义的左房异常、种族和未来卒中之间的关系。到时候它会的 确定GCNKSS在提示潜在的心房血栓形成原因的标志物中的黑白差异 中风的可能性。具体目标1将检验黑人左房异常患病率较高的假设， 左房异常与未来的中风有关，左房异常导致 黑人中风的风险更高。《特定目标2》将检验黑人缺血性中风患者的假说 更常见的是心电图明确的左房异常，较少的是超声心动图左房 比白人更大。所有的心电图和超声心动图图像的子集将被集中解释。这 研究承诺表明，黑人较高的中风风险在一定程度上反映了 卒中。这些发现可能最终导致使用现有的被批准用于房颤的药物进行治疗。