ECHOCARDIOGRAPHIC STROKE PREDICTORS IN A TRI-ETHNIC COMM

描述（改编自申请人的摘要）：候选人以前的 活动一直致力于面向病人的研究。近年来 重点关注使用超声心动图来识别新的心源性栓塞来源 对于缺血性中风，特别是卵圆孔未闭和主动脉弓斑块， 并获得了NINDS的两笔R 01赠款。的 候选人的总体职业目标是继续在该领域的研究 心源性卒中，有助于解释一些 隐源性脑卒中的合理预防和治疗 approach.候选人还致力于指导年轻的调查人员， 他长期成功的心脏病学培训证明了这一点。 哥伦比亚大学是培养候选人职业生涯的理想环境 增长，因为强大的，基础设施的临床研究， 世界知名心脏病专家和神经科专家的会诊， 合作，以及坚定的机构承诺，以病人为导向 research.对候选人的职业发展至关重要的将是过渡 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。提出了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 和几何模式，左室射血分数降低，节段性室壁运动 异常和左心房扩大缺血性卒中的风险， 三种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 也将被评估。次要目的是评价 传统中风危险因素的风险，以及风险评估 与不太常见的异常（卵圆孔未闭，二尖瓣 瓣环钙化、二尖瓣脱垂）。最后，A的流行 将对每个种族-种族组的卵圆孔未闭进行评价。队列 2500名55岁以上的白色、黑人和西班牙裔成年人将从 正在进行的北方曼哈顿卒中研究（NOMASS），确保具有成本效益 招募、数据收集和后续行动。二维超声心动图 将进行造影剂注射。一种新的三维技术 也将用于评估LVH。将进行年度电话随访 以确定中风心肌梗塞和死亡亲自随访将 在可疑结局的受试者和随机10%的队列中进行。 Kaplan Meier曲线和Cox比例风险模型将用于 计算调整后的事件发生率，并评估 根据人口统计学和卒中调整对卒中和血管事件的兴趣 危险因素在900例受试者的亚组中，将重复进行超声心动图检查 在首次研究超声心动图检查的3年后， 异常这项研究将是第一项前瞻性队列研究， 评估多种超声心动图危险因素对缺血性心脏病的作用 中风在一个社区的白人，黑人和西班牙裔生活在同一地区。

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.