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.

Agency
National Institute of Health (NIH)
Institute
National Institute of Nursing Research (NINR)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
1K23NR009716-01
Application #
7018078
Study Section
National Institute of Nursing Research Initial Review Group (NRRC)
Program Officer
Huss, Karen
Project Start
2005-09-27
Project End
2008-07-31
Budget Start
2005-09-27
Budget End
2006-07-31
Support Year
1
Fiscal Year
2005
Total Cost
$130,428
Indirect Cost
Name
State University of New York at Buffalo
Department
Type
Schools of Nursing
DUNS #
038633251
City
Buffalo
State
NY
Country
United States
Zip Code
14260
Al-Zaiti, Salah S; Fallavollita, James A; Canty, John M et al. (2015) The prognostic value of discordant T waves in lead aVR: A simple risk marker of sudden cardiac arrest in ischemic cardiomyopathy. J Electrocardiol 48:887-92
Al-Zaiti, Salah S; Fallavollita, James A; Canty Jr, John M et al. (2014) Electrocardiographic predictors of sudden and non-sudden cardiac death in patients with ischemic cardiomyopathy. Heart Lung 43:527-33
Pelter, Michele M; Kozik, Teri M; Loranger, Denise L et al. (2012) A research method for detecting transient myocardial ischemia in patients with suspected acute coronary syndrome using continuous ST-segment analysis. J Vis Exp :
Carey, Mary G; Al-Zaiti, Salah S; Canty Jr, John M et al. (2012) High-risk electrocardiographic parameters are ubiquitous in patients with ischemic cardiomyopathy. Ann Noninvasive Electrocardiol 17:241-51
Carey, Mary G; Al-Zaiti, Salah S; Liao, Limei M et al. (2011) A low-glycemic nutritional fitness program to reverse metabolic syndrome in professional firefighters: results of a pilot study. J Cardiovasc Nurs 26:298-304
Carey, Mary G; Luisi Jr, Andrew J; Baldwa, Sunil et al. (2010) The Selvester QRS Score is more accurate than Q waves and fragmented QRS complexes using the Mason-Likar configuration in estimating infarct volume in patients with ischemic cardiomyopathy. J Electrocardiol 43:318-25