Dynamic ECG Predictors of Sudden Cardiac Death in Ischemia Cardiomyopathy

描述（由申请人提供）：本申请的指导患者导向研究职业发展奖（K23）旨在为候选人提供一段时间的培训，该候选人是纽约州立大学布法罗大学护理学院的助理教授，有博士学位。该建议的主要目的是确定缺血性心肌病患者心源性猝死（SCD）的心电图（ECG）标志物。该研究将招募既往有心肌梗死（Ml）和左心室功能差的患者。获取高分辨率（1000Hz采样）12导联心电图，分析静息和动态变化，包括心肌缺血（ST段）和复极异常（T波）。候选人在生理护理方面的广泛培训侧重于急性冠状动脉综合征（心肌缺血）住院患者的心电图研究。因此，候选人在心电图方面的优势为她的建议做好了准备，同时扩大了她分析慢性心肌病门诊患者复极异常的专业知识。这个K23将允许候选人在她的导师John M. Canty Jr.医学博士的指导下，在研究设计和方法、统计方法、科学写作和资助方面发展所需的额外技能。在整个资助期间，计划了各种正式和非正式的教学，以最大限度地提高候选人的科学成长。该奖项的大部分将用于一项前瞻性观察研究的监督实施，该研究旨在通过心电图预测高危患者猝死的可能性。从K23奖项中获得的技能、培训和数据将用于支持候选人开发R01应用程序。在公共卫生方面，医疗保险和医疗补助关于植入式心脏除颤器（ICD）植入的指南也包括这些患者，那些先前有Ml和左心室功能差的患者。虽然有研究支持，但ICD植入的有效性值得关注，因为(1)它不能识别超过一半的SCD事件，(2)与该治疗相关的高成本，(3)ICD患者注意到的应激生理效应包括抑郁、焦虑、愤怒和敌意。因此，开发一种方法来识别与心律失常死亡高风险相关的ECG变化，可以显著提高ICD治疗患者的准确选择。

DESCRIPTION (provided by applicant): This application for a Mentored Patient-Oriented Research Career Development Award (K23) is designed to support a period of training to the candidate, a doctorally-prepared nurse who is an Assistant Professor in the School of Nursing at The University at Buffalo, the State University of New York. The primary aim of the proposal is to identify electrocardiographic (ECG) markers of sudden cardiac death (SCD) in ischemic cardiomyopathic patients. The study will enroll patients who have had a prior myocardial infarction (Ml) and poor left ventricular function. A high resolution (1000Hz sampling) 12-lead ECG obtained and analyzed for both resting and dynamic changes including myocardial ischemia (ST segment) and repolarization abnormalities (T wave). The candidate's extensive training in physiological nursing has focused on ECG studies of hospitalized patients with acute coronary syndromes (myocardial ischemia). Thus, the candidates' strengths in electrocardiography prepare her well for the proposal while expanding her expertise to analyze repolarization abnormalities in ambulatory patients with chronic cardiomyopathies. This K23 will allow the candidate, guided by her mentor John M. Canty Jr., MD, to develop additional skills needed in the research design and methods, statistical methods, scientific writing and grantsmanship. A variety of formal and informal didactics are planned throughout the funding period to maximize the candidate scientific growth. The majority of the award will be devoted to the supervised implementation of a prospective observational study that is intended to electrocardiographically predict the likelihood of sudden death in patients at greatest risk. The skills, training and data obtained from this K23 award will be used to support the candidate's development of an R01 application. In regard to public health, Medicare and Medicaid guidelines for implantable cardiac defibrillator (ICD) implantation include these same patients, those with a prior Ml and poor left ventricular function. While supported by research, the effectiveness of ICD implantation is of concern because (1) it fails to identify over half of the SCD events, (2) the high cost associated with this therapy and (3) the physiologic effects of stress noted in ICD patients include depression, anxiety, anger and hostility. Therefore, developing an approach to identify ECG changes associated with a high risk of arrhythmic death could markedly improve accurate patient selection for ICD therapy.