CARDIAC PERFORMANCE BY QUANTITATIVE ECHOCARDIOGRAPHY

Project: Research project

Project Details

Description

DESCRIPTION (Applicant?s Abstract)
The candidate is a 42-year-old tenured Associate Professor who is in his 11th
year after fellowship training. He is an established independent investigator
who is completely committed to a life-long career in research and the
mentoring of trainees. His outstanding institutional environment is
supportive of high quality collaboration and ongoing research. This Midcareer
Investigator Award in Patient-Oriented Research proposal will enable the
expansion of two principal areas of hypotheses-driven human research: 1)
Effects of cytokines on left ventricular (LV) performance in patients
undergoing cardiac surgery and 2) Assessment of contractile reserve to predict
prognosis in heart failure patients. The American Heart Association has
recently awarded a National Grant-In-Aid entitled "Effects of Inflammatory
Mediators on Left Ventricular Performance Following Cardiac Surgery" to the
applicant as PI. This 3-year grant will support the infrastructure that is a
requirement of this K24 application. A specific aim is to test the hypothesis
that inflammatory mediators play an important role in cardiac depression
following coronary bypass surgery. In particular, expression of the cytokine
TNF- alpha will be studied both systemically and locally in coronary sinus
samples. Seventy-two patients will be studied before and after bypass using
transesophageal echo automated border detection and high fidelity pressure
catheters to quantify LV performance in a predominant load-independent manner
using pressure-volume relations. The anti-cytokine role of adenosine will be
explored by randomizing patients to receive either routine cardioplegeia or an
adenosine cardiopledgia. This K24 award will allow the applicant to expand
this research work and mentor research fellows by directly involving them in
this and related projects. The second arm of this proposal will test the
hypothesis that contractile reserve is an important prognostic determinant in
patients with severe heart failure. Dobutamine echocardiography will
noninvasively assess the functionality of the myocardial beta-adrenergic
receptor complex in 100 heart failure patients with ejection fraction less
than 35%. Quantitative automated border detection and tissue Doppler will be
used. Contractile reserve will be tested as a marker for patient?s prognosis
using: preload-adjusted maximal power, tissue Doppler measures of longitudinal
shortening velocity, and right ventricular fractional area change. The
inability to augment ventricular contractility in response to dobutamine will
be tested as a marker predictive of cardiac morbidity or mortality within one
year. Patients will be followed for adverse events defined as requirements
for hospitalization for heart failure, continuous intravenous inotropic or
mechanical circulatory support. This information has promise to dramatically
impact on the clinical management of these patients, including priority status
for transplantation or mechanical circulatory assist device implantation.
These ongoing studies provide ample opportunities for mentoring of fellows in
patient-oriented research.
StatusFinished
Effective start/end date7/1/014/30/11

Funding

  • National Heart, Lung, and Blood Institute: $148,665.00
  • National Heart, Lung, and Blood Institute: $119,554.00
  • National Heart, Lung, and Blood Institute: $119,554.00
  • National Heart, Lung, and Blood Institute: $119,554.00
  • National Heart, Lung, and Blood Institute: $148,665.00
  • National Heart, Lung, and Blood Institute: $148,665.00
  • National Heart, Lung, and Blood Institute: $119,554.00
  • National Heart, Lung, and Blood Institute: $148,665.00
  • National Heart, Lung, and Blood Institute: $148,665.00
  • National Heart, Lung, and Blood Institute: $119,554.00

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