Gardin Julius M, Arnold Alice M, Polak Joseph, Jackson Sharon, Smith Vivienne, Gottdiener John
Division of Cardiology, Department of Medicine, University of California, Irvine, California, USA.
Am J Cardiol. 2006 Jan 15;97(2):270-5. doi: 10.1016/j.amjcard.2005.08.039.
Echocardiographic measures of left ventricular (LV) function and structure as well as left atrial size have been reported to predict adverse cardiovascular disease (CVD) outcomes. Although anatomic changes of the aortic root are likely to reflect effects of hypertension and atherosclerosis, few data are available on the predictive value of aortic root dimension (ARD) for outcome in free-living populations. The purpose of this investigation was to determine whether in a cohort of patients aged > or = 65 years ARD was associated with traditional coronary heart disease (CHD) risk factors and with 10-year incident CVD outcomes. In the National Heart, Lung, and Blood Institute-sponsored Cardiovascular Health Study, 3,933 free-living black and white men and women > or = 65 years of age without prevalent CVD had 2-dimensional directed M-mode echocardiographic measurements of ARD as part of a comprehensive evaluation. ARD was associated with age and gender (greater in men) but not race. ARD was also positively associated with diastolic blood pressure, LV hypertrophy, major electrocardiographic abnormalities, and other echocardiographic measures, including LV mass, ventricular septal and posterior wall thickness, and LV dimension. After adjustment for other known risk factors, high ARD was associated with an increased risk for incident congestive heart failure (CHF) in men (hazard ratio for upper compared with all other quintiles 1.47, p = 0.014), stroke in men and women (hazard ratio 1.39 per cm, p = 0.015), CVD mortality in men and women (hazard ratio 1.48 per cm, p = 0.007), and total mortality in men and women taking antihypertensive medications (hazard ratio 1.46 per cm, p = 0.007), but not with incident myocardial infarction (MI) (hazard ratio 0.89, p = 0.39). In conclusion, in a cohort of patients aged > or = 65 years without clinical CVD at baseline, ARD was associated with several CHD risk factors and measures of subclinical disease and was predictive of incident CHF, stroke, CVD mortality, and all-cause mortality, but not of incident MI.
据报道，超声心动图测量的左心室（LV）功能和结构以及左心房大小可预测不良心血管疾病（CVD）结局。虽然主动脉根部的解剖学变化可能反映高血压和动脉粥样硬化的影响，但关于主动脉根部直径（ARD）对自由生活人群结局的预测价值的数据却很少。本研究的目的是确定在年龄≥65岁的患者队列中，ARD是否与传统冠心病（CHD）危险因素以及10年CVD发病结局相关。在国立心肺血液研究所资助的心血管健康研究中，3933名年龄≥65岁、无CVD病史的自由生活的黑人和白人男性及女性接受了二维定向M型超声心动图测量ARD，这是综合评估的一部分。ARD与年龄和性别相关（男性更大），但与种族无关。ARD还与舒张压、左心室肥厚、主要心电图异常以及其他超声心动图测量指标呈正相关，包括左心室质量、室间隔和后壁厚度以及左心室直径。在对其他已知危险因素进行调整后，高ARD与男性发生充血性心力衰竭（CHF）的风险增加相关（最高五分位数与所有其他五分位数相比的风险比为1.47，p = 0.014），与男性和女性发生中风的风险增加相关（每厘米风险比为1.39，p = 0.015），与男性和女性的CVD死亡率增加相关（每厘米风险比为1.48，p = 0.007），与服用抗高血压药物的男性和女性的全因死亡率增加相关（每厘米风险比为1.46，p = 0.007），但与发生心肌梗死（MI）无关（风险比为0.89，p = 0.39）。总之，在基线时无临床CVD的年龄≥65岁的患者队列中，ARD与多种CHD危险因素和亚临床疾病测量指标相关，并且可预测CHF、中风、CVD死亡率和全因死亡率的发生，但不能预测MI的发生。
