Profiling Biobehavioral Responses to Mechanical Support in Advanced Heart Failure

描述（由申请人提供）：心力衰竭（HF）是美国增长最快的心血管疾病，也是老年人住院的最常见原因。许多HF患者在休息时或轻微运动时出现症状，这些症状对最佳药物治疗无效。这些晚期HF患者中只有不到5%符合心脏移植的条件，器官捐赠也非常有限。因此，使用心室辅助装置（VAD）的机械循环支持已成为晚期HF的主要治疗方法。VAD植入后的临床结局和生活质量存在显著且无法解释的异质性。此外，我们对身体和心理症状如何与潜在HF发病机制的变化相关以及症状和致病生物标志物如何解释VAD植入的差异反应知之甚少。因此，我们的研究目标是：a）表征从晚期HF过渡到VAD植入后前6个月期间症状和致病性生物标志物变化的常见和不同轨迹，以及B）将症状和生物标志物随时间的变化与临床事件和生活质量联系起来。我们将收集一组120名晚期HF成人患者在植入VAD之前和之后6个月的数据。我们的目标是：1）确定生理和心理症状变化的常见轨迹，2）表征心肌应激、全身炎症和内皮功能障碍的血清生物标志物变化的常见轨迹，3）量化接受VAD植入的成人中症状和发病机制生物标志物之间的关联。重要的是，我们将根据临床事件风险和健康相关生活质量编纂不同症状和生物标志物轨迹的临床相关性。这项跨学科的临床研究整合和推进了先前的生物学和行为学研究，并以一种先进的技术治疗一种备受瞩目的心血管疾病为中心。这些研究结果将用于增强患者和供应商关于VAD植入的共同决策，并塑造急需的新一代干预措施和临床管理策略，这些策略针对VAD植入的不同症状和致病反应。 公共卫生相关性：这项研究涉及晚期心力衰竭的主要治疗，这是美国增长最快的心血管疾病。这项研究的结果将用于加强患者和提供者关于心力衰竭先进疗法的决策，并开发个性化干预措施，以改善以患者为导向的临床结局。

DESCRIPTION (provided by applicant): Heart failure (HF) is the fastest growing cardiovascular disorder in the U.S., and the most common reason for hospitalization among older adults. Many patients with HF have symptoms at rest or with minimal exertion that become refractory to optimal medical therapy. Fewer than 5% of these advanced HF patients are eligible for heart transplantation, and organ donations are extremely limited. As such, mechanical circulatory support with a ventricular assist device (VAD) has emerged as a primary treatment for advanced HF. There is significant and unexplained heterogeneity in clinical outcomes and quality-of-life after VAD implantation. Moreover, we know very little about how physical and psychological symptoms may relate to changes in underlying HF pathogenesis and how symptoms and pathogenic biomarkers may explain differential responses to VAD implantation. Accordingly, our research goals are to a) characterize common and distinct trajectories of change in symptoms and pathogenic biomarkers during the transition from advanced HF through the first 6 months after VAD implantation, and b) link changes in symptoms and biomarkers over time to clinical events and quality-of-life. We will collect data from a cohort of 120 adults with advanced HF prior to, and for a period of 6 months after VAD implantation. Our aims are to: 1) identify common trajectories of change in physical and psychological symptoms, 2) characterize common trajectories of change in serum biomarkers of myocardial stress, systemic inflammation, and endothelial dysfunction, and 3) quantify associations between symptoms and biomarkers of pathogenesis in adults undergoing VAD implantation. Importantly, we will codify the clinical relevance of different symptom and biomarker trajectories in terms of clinical-event risk and health-related quality-of-life. This interdisciplinary clinical research integrates and advances prior biological and behavioral research and is centered on an advanced technological treatment of a high profile cardiovascular disorder. These research findings will be used to enhance shared patient and provider decision-making regarding VAD implantation, and to shape a much-needed new breed of interventions and clinical management strategies that are tailored to differential symptom and pathogenic responses to VAD implantation. PUBLIC HEALTH RELEVANCE: This study involves a primary treatment for advanced heart failure, the fastest growing cardiovascular disorder in the United States. The results of this stud will be used to enhance patient and provider decision-making about advanced therapies for heart failure, and to develop personalized interventions to improve patient- oriented and clinical outcomes.