Epidemiologic Determinants of Change in Cardiac Structure and Function (ECHO-SOL 2)

 描述（由申请人提供）：西班牙裔在心力衰竭（HF）临床试验和流行病学研究中代表性不足。合同资助的西班牙裔社区健康研究/拉丁美洲人研究（HCHS/SOL）不包括基线超声心动图检查的规定。NIH资助的拉丁美洲人超声心动图研究（ECHO-SOL; PI Dr. Rodriguez）帮助填补了这一关键空白。我们在HCHS/SOL基线队列的代表性子集中使用组织多普勒和斑点跟踪等技术成功进行了回波检查。我们的初步数据显示，尽管西班牙裔美国人的年龄相对较低（56 ± 0.4岁），但左心室（LV）肥大、LV几何结构异常和舒张功能障碍的患病率高于先前报道的非西班牙裔白人。此外，文化适应，一个与西班牙裔相关但与HF风险相关的未充分研究的因素，与心脏结构和功能异常的较高患病率显著相关。在HF中，从A期（仅HF风险因素）到B期（心脏结构和功能异常）再到C期（临床症状性HF; EF [HFpEF]保留或EF [HFrEF]降低）的进展是一个非常重要的过程。缺乏关于少数种族/民族HF分期进展的纵向队列研究。纵向数据对于确定从A期到B期HF的心脏表型变化的不同模式是否可以识别处于发展为临床HF的轨迹上的个体是必不可少的。非西班牙裔人群（如FHS和CHS）显示，4-5年内心脏超声参数的变化可以预测HF事件。我们的ECHO-SOL数据显示了在我们独特的队列中使用连续超声检查评估心脏进展的可行性。然而，目前合同资助的HCHS/SOL第二次检查不包括ECHO-SOL参与者的超声心动图检查。因此，我们建议利用ECHO-SOL和HCHS/SOL第二次检查的独特资源，以便在基线后平均5年在ECHO-SOL队列中重复高质量超声心动图（ECHO-SOL 2）。总体目标是确定传统HF风险因素的转变如何影响纵向 通过评估与丰富的临床、社会文化、社会经济和心理社会HCHS/SOL数据库相关的超声参数的系列变化来评估心脏异常的变化。ECHO-SOL 2代表了一种创新且具有成本效益的方法，可促进我们对HF风险因素进展与心脏结构和功能异常进展之间联系的理解。ECHO-SOL 2将识别HF风险因素进展的模式和早期心功能不全的轨迹，这些模式和轨迹可以区分西班牙裔成年人是否更有可能发生HF;利用心脏结构和收缩/舒张功能的常规评估与更新颖的超声心动图测量（LV应变和扭转）的联合作用。ECHO-SOL 2将有助于筛查和识别HF风险最高的西班牙裔美国人，然后可以有针对性地进行积极的风险因素控制，以降低该脆弱人群的临床HF负担。

 DESCRIPTION (provided by applicant): Hispanics are under-represented in heart failure (HF) clinical trials and epidemiologic studies. The contract funded Hispanic Community Health Study/Study of Latinos (HCHS/SOL) did not include a provision for a baseline echo exam. The NIH-funded Echocardiographic Study of Latinos (ECHO-SOL; PI Dr. Rodriguez) helped fill this critical gap. We successfully performed echo exams using techniques such as tissue Doppler and speckle tracking in a representative subset of the HCHS/SOL baseline cohort. Our preliminary data show that despite a relatively young age of 56+0.4 years, the prevalence of left ventricular (LV) hypertrophy, abnormal LV geometry and diastolic dysfunction is higher among Hispanics than previously reported in non- Hispanic whites. In addition, acculturation, a factor relevant to Hispanics but understudied in relation to HF risk, was significantly associated with a higher prevalence of cardiac structural and functional abnormalities. In HF, progression from Stage A (HF risk factors alone) to Stage B (abnormalities of cardiac structure and function) to Stage C (clinical symptomatic HF; either with preserved [HFpEF] or reduced EF [HFrEF]) is an incredibly important process. There is a shortage of longitudinal cohort studies on progression across the HF stages in racial/ethnic minorities. Longitudinal data are essential to determine if distinct patterns of change in cardiac phenotypes from stage A to B HF can identify individuals on a trajectory towards developing clinical HF. Cohorts of non-Hispanics, such as the FHS and CHS, show that changes in cardiac echo parameters within a 4-5 year period can predict incident HF. Our ECHO-SOL data show the feasibility of assessing cardiac progression with serial echo exams in our unique cohort. However, the current contract funded HCHS/SOL 2nd exam does not include echo exams on ECHO-SOL participants. Thus, we propose to leverage the unique resources of ECHO-SOL and the HCHS/SOL 2nd exam in order to repeat a high quality echo (ECHO-SOL 2) in the ECHO-SOL cohort on average five years post- baseline. The overall goal is to determine how the transition in traditional HF risk factors impacts longitudinal change of cardiac abnormalities by assessing serial change in echo parameters in relation to the rich clinical, sociocultural, socioeconomic and psychosocial HCHS/SOL database. ECHO-SOL 2 represents an innovative and cost-effective approach to advance our understanding of the links between progression of HF risk factor with progression of abnormal cardiac structure and function. ECHO-SOL 2 will identify patterns of HF risk factor progression and the trajectory of early cardiac dysfunction that can differentiate Hispanic adults as more or less likely to develop HF; utilizing the conjoint contributions of conventional assessment of cardiac structure and systolic / diastolic function with more novel echo measures (LV strain and twist). ECHO-SOL 2 will facilitate the screening and identification of Hispanics who are at greatest HF risk, and can then be targeted for aggressive risk factor control to lower the burden of clinical HF in this vulnerable population.