ECHOCARDIOGRAPHIC STROKE PREDICTORS IN A TRI-ETHNIC COMM

描述(改编自申请人的摘要)：应聘者的过去 活动一直致力于以患者为中心的研究。近年来，他已经 重点是使用超声心动图来确定新的心源性栓塞源 对于缺血性中风，特别是卵圆孔未闭和主动脉弓斑块， 并因这些努力获得了NINDS的两笔R01奖金。这个 应聘者的总体职业目标是继续他在 心脏栓塞性中风，有助于解释一些 因此对隐源性中风进行合理预防和治疗 接近。候选人还致力于指导年轻的调查人员，因为 由他长期而成功的心脏病学训练记录下来，伙计们。 哥伦比亚大学是培养求职者职业生涯的理想环境 增长得益于强大的临床研究基础设施， 出席世界知名心脏病专家和神经科专家的会诊和 协作，以及坚定的机构承诺以患者为本 研究。对候选人的职业发展至关重要的是过渡 从迄今为止进行的相对较小的病例对照研究到拟议的 亚临床超声心动图异常的大型前瞻性研究 中风风险。建议进行一项基于人群的前瞻性队列研究 确定左心室肥厚(LVH)的独立贡献 几何构型、左室射血分数降低、节段性室壁运动 异常和左房增大与缺血性卒中和 三个民族人群中的血管事件，以及 剂量-反应关系。随着时间的推移，这些异常的进展 也将接受评估。次要目标将是评估对 风险由传统的中风危险因素决定，并对风险进行评估 与不太常见的畸形有关(卵圆孔未闭、二尖瓣未闭 环状钙化、二尖瓣脱垂)。最后，艾滋病的流行 将对每个种族-民族的卵圆孔未闭进行评估。一群 2500名55岁以上的白人、黑人和西班牙裔成年人将从 正在进行的曼哈顿北部卒中研究(NOMASS)，确保经济高效 招聘、数据收集和后续工作。二维超声心动图 进行对比剂注射。一种新的三维技术 也将被用来评估左心室肥厚。每年都会进行电话跟踪 以确定中风、心肌梗死和死亡。面对面的跟进将 在结果可疑的受试者和队列中随机10%的人中进行。 将使用Kaplan Meier曲线和Cox比例风险模型 计算调整后的事故率并评估暴露于 对中风和血管事件的兴趣根据人口统计学和中风进行调整 风险因素。在900名受试者中，将重复进行超声心动图检查。 超声心动图首次检测3年后进展 异常现象。这项研究将是第一项前瞻性队列研究 评价多种超声心动图危险因素在脑缺血中的作用 在居住在同一地区的白人、黑人和西班牙裔美国人组成的社区中风。

DESCRIPTION (Adapted From The Applicant's Abstract): The candidate's previous activity has been devoted to patient-oriented research. In recent years, he has focused on the use of echocardiography to identify new cardioembolic sources for ischemic stroke, especially patent foramen ovale and aortic arch plaques, and has`been awarded two R01 grants from NINDS for such efforts. The candidate's overall career goal is to continue his research in the field of cardioembolic stroke, contributing to the explanation of the mechanisms of some cryptogenic strokes and therefore to a rational preventive and therapeutic approach. The candidate is also committed to mentoring young investigators, as documented by his long-standing and successful training of cardiology, fellows. Columbia University is an ideal environment to foster the candidate's career growth because of the strong, infrastructure for clinical research, the presence of world renowned cardiologists and neurologists for consultation and collaboration, and the firm institutional commitment to patient-oriented research. Crucial to the candidate's career development will be the transition from the relatively small case-control studies performed so far to the proposed large prospective study of subclinical echocardiocraphic abnormalities and stroke risk. A population-based prospective cohort study is proposed to determine the independent contribution of left ventricular hypertrophy (LVH) and geometric pattern, decreased LV ejection fraction, segmental wall motion abnormalities and left atrial enlargement to the risk of ischemic stroke and vascular events in a tri-ethnic population, and the existence of a dose-response relationship. The progression of these abnormalities over time will also be assessed. Secondary aims will be to evaluate the modification of risk by traditional stroke risk factors, and the assessment of the risk associated with less frequent abnormalities (patent foramen ovale, mitral annular calcification, mitral valve prolapse). Finally, the prevalence of a patent foramen ovale in each race-ethnic group will be evaluated. A cohort of 2500 white, black and Hispanic adults over age 55 will be enrolled from the ongoing Northern Manhattan Stroke Study (NOMASS), assuring cost-effective recruitment, data collection and follow-up. Two-dimensional echocardiography with contrast injection will be performed. A new three-dimensional technique will also be used to assess LVH. Annual telephone follow-up will be performed to ascertain stroke, myocardial infarction and death. In-person follow-up will be done in subjects with suspected outcome and in a random 10% of the cohort. Kaplan Meier curves and Cox-proportional hazard models will be used to calculate adjusted event rates and assess the dependence of exposures of interest on stroke and vascular events adjusting for demographics and stroke risk factors. In a subgroup of 900 subjects, echocardiography will be repeated 3 years after the first test to study the progession of echocardioaraphic abnormalities. This study will be the first prospective cohort study to evaluate the role of multiple echocardiographic risk factors for ischemic stroke in a community of whites, blacks and Hispanics living in the same area.