Heart Rate Fragmentation: New Biomarker of Atrial Fibrillation Risk

心率碎片：心房颤动风险的新生物标志物

• 批准号: 9815654
• 负责人: Madalena D Costa
• 金额: $ 59.59万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-10 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9815654
• 关键词: Age; Ambulatory Electrocardiography; Arrhythmia; Atherosclerosis Risk in Communities; Atrial Fibrillation; Biological Markers; Blood coagulation; Brain; Cardiac; Cardiac health; Cardioscopes; Cardiovascular Diseases; Cardiovascular system; Cessation of life; Characteristics; Clinical; Cohort Studies; Data; Defibrillators; Dementia; Development; Electrophysiology (science); Embolism; Frequencies; Goals; Heart Abnormalities; Heart Atrium; Heart Diseases; Heart Rate; Heart failure; Hour; Impaired cognition; Implant; Individual; Ischemia; Left; Left Atrial Function; Left Ventricular Ejection Fraction; Left Ventricular Mass; Left atrial structure; Link; Magnetic Resonance Imaging; Measurement; Measures; Modeling; Monitor; Multi-Ethnic Study of Atherosclerosis; Myopathy; National Heart, Lung, and Blood Institute; Neurologic; Pacemakers; Participant; Patients; Plant Roots; Population; Prevention; Process; Public Health; Regulation; Research; Research Project Grants; Risk; Risk Factors; Sinoatrial Node; Sleep; Stroke; Structure; Symptoms; Technology; Ventricular; Work; cardiovascular disorder risk; cardiovascular health; clinical care; cognitive function; cognitive testing; embolic stroke; heart electrical activity; heart function; heart rate variability; heart rhythm; indexing; member; monitoring device; offspring; precision medicine; prospective; stroke risk; structural heart disease; tool

PROJECT SUMMARY / ABSTRACT Atrial fibrillation (AF), a common arrhythmia, is associated with substantially elevated risks of stroke, cognitive decline, dementia, arterial emboli, heart failure, and cardiovascular death. Existing studies of AF generally investigate AF that has been clinically recognized, but studies in patients with implanted monitoring devices such as pacemakers or defibrillators indicate that a large proportion of AF episodes produce no symptoms at all and are undetected clinically. Furthermore, complications commonly attributed to AF, including embolic stroke, often occur in individuals with alterations of left atrial structure and function (atrial myopathy) but in the absence of clinically recognized AF. Therefore, clinical presentation with AF may represent a late stage in the pathophysiologic process linking atrial myopathy with serious complications including stroke and cognitive decline. New biomarkers are needed that reflect atrial myopathy and are highly predictive of AF and its complications. In the proposed research project, we will study newly developed heart rate (HR) fragmentation metrics computed from long-term electrocardiographic (ECG) recordings. Our preliminary data support the hypothesis that these new HR fragmentation metrics, developed by members of our investigative team, reflect breakdown of the neuroautonomic-electrophysiologic network controlling the sino-atrial node and its regulation of heart rate, and are highly predictive of both AF and cognitive impairment. In the setting of the Multi-Ethnic Study of Atherosclerosis (MESA), we propose to compute HR fragmentation indices from overnight ECG recordings and determine the association of HR fragmentation with cardiac structure assessed by MRI, with incident AF, and with brain structure and function assessed by MRI and cognitive testing. In exploratory analyses, we will use data from 14-day ambulatory ECG monitors to determine the short-term relationship of paroxysmal AF with HR fragmentation. Data from the Sleep Heart Health Study cohorts will be used to replicate findings from MESA for our primary aim. Our research will determine the extent to which HR fragmentation is a biomarker of altered left atrial structure and function, clinically recognized AF, and neurological complications of AF including impaired cognitive function and microvascular ischemia. With recent developments in mobile monitoring technology, noninvasive ambulatory ECG monitoring overnight or for longer periods is now practical. The measurement of HR fragmentation from these ECG recordings can be automated. Thus, if HR fragmentation is indeed a biomarker of atrial myopathy, AF, and its complications, information from noninvasive ECG monitoring may inform clinical care, including decisions about therapy to reduce the risk of stroke.

项目摘要/摘要 心房颤动(房颤)是一种常见的心律失常，与中风的风险显著增加有关，认知 衰弱、痴呆、动脉血栓、心力衰竭和心血管死亡。现有的房颤研究总体上 调查已被临床确认的房颤，但对植入监测装置的患者进行研究 例如起搏器或除颤器表明很大比例的房颤发作在 所有这些都是临床上未发现的。此外，通常被归因于房颤的并发症，包括血栓 中风，常发生在左房结构和功能改变(房肌病)的个体中，但在 没有临床公认的房颤。因此，房颤的临床表现可能代表了房颤的晚期。 心房肌病与中风和认知等严重并发症的病理生理过程 拒绝。需要新的生物标志物来反映心房肌病，并高度预测房颤及其 并发症。在拟议的研究项目中，我们将研究新开发的心率(HR)碎片 根据长期心电(ECG)记录计算的指标。我们的初步数据支持 假设我们的调查团队成员开发的这些新的人力资源碎片化指标反映了 控制窦房结的神经自主神经电生理网络的破坏及其调节 心率的变化，对房颤和认知损害都有很高的预测性。在多民族的背景下 动脉粥样硬化(MESA)的研究，我们建议从隔夜心电图计算心率碎裂指数 记录，并确定心率碎裂与MRI评估的心脏结构的关联， 发生房颤，并通过核磁共振和认知测试评估脑结构和功能。处于探索性阶段 分析，我们将使用14天动态心电监护仪的数据来确定 阵发性房颤伴心率碎裂。来自睡眠心脏健康研究队列的数据将被用于 为我们的主要目标复制MESA的发现。我们的研究将决定HR在多大程度上 碎裂是左房结构和功能改变、临床可识别的房颤的生物标志物，以及 房颤的神经系统并发症包括认知功能受损和微血管缺血。使用最近的 移动监护技术的发展，无创动态心电监护通宵或更长时间 现在，经期是可行的。来自这些心电记录的心率碎片的测量可以是 自动化的。因此，如果心率碎裂确实是心房肌病、房颤及其并发症的生物标志物， 来自非侵入性心电监测的信息可能为临床护理提供信息，包括关于治疗的决定 降低中风的风险。