高血压和吸烟与无症状个体左心室局部功能降低有关：动脉粥样硬化多民族研究。
Hypertension and smoking are associated with reduced regional left ventricular function in asymptomatic: individuals the Multi-Ethnic Study of Atherosclerosis.
作者信息
Rosen Boaz D, Saad Mohammed F, Shea Steven, Nasir Khurram, Edvardsen Thor, Burke Gregory, Jerosch-Herold Michael, Arnett Donna K, Lai Shenghan, Bluemke David A, Lima João A C
机构信息
Division of Cardiology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
出版信息
J Am Coll Cardiol. 2006 Mar 21;47(6):1150-8. doi: 10.1016/j.jacc.2005.08.078. Epub 2006 Feb 23.
OBJECTIVES
This study sought to test the hypothesis that reduced regional left ventricular (LV) function is associated with traditional risk factors including hypertension, hypercholesterolemia, and smoking in asymptomatic individuals.
BACKGROUND
Coronary artery disease is the main etiology of congestive heart failure in the U.S. and Europe. However, the relationship between risk factors for coronary artery disease and decreased myocardial function has not been studied systematically in asymptomatic individuals.
METHODS
The Multi-Ethnic Study of Atherosclerosis (MESA) is a cohort study designed to investigate the nature of atherosclerosis in asymptomatic individuals. A total of 1,184 participants (45 to 84 years old) underwent tagged cardiac magnetic resonance imaging. Regional LV function was quantified by analyzing peak systolic circumferential strain (Ecc) in regions corresponding to the left anterior descending (LAD), circumflex (LCX), and right coronary (RCA) territories. The association between risk factors and strains was studied using multiple linear regression.
RESULTS
Higher diastolic blood pressure (DBP) was associated with lower Ecc (p < or = 0.002). The Ecc's in the LAD territory of participants with DBP <80, 80 to 84, 85 to 89, and > or =90 mm Hg were -15.6%, -14.8%, -14.2%, and -13.7%, respectively (p < 0.001). Similar results were documented in other territories and after multivariable analysis. Smokers had lower Ecc in the LAD and RCA regions compared with nonsmokers. Furthermore, dose response relationship between cigarette consumption measured in pack-years and regional LV dysfunction by Ecc was noted (p < or = 0.01 in LAD and RCA territories). Finally, combined diastolic hypertension and smoking was associated with a greater reduction of regional LV function.
CONCLUSIONS
Higher diastolic blood pressure and smoking are associated with decreased regional LV function in asymptomatic individuals.
目的
本研究旨在验证以下假设：在无症状个体中，局部左心室（LV）功能降低与包括高血压、高胆固醇血症和吸烟在内的传统危险因素相关。
背景
在美国和欧洲，冠状动脉疾病是充血性心力衰竭的主要病因。然而，在无症状个体中，尚未对冠状动脉疾病危险因素与心肌功能降低之间的关系进行系统研究。
方法
动脉粥样硬化多民族研究（MESA）是一项队列研究，旨在调查无症状个体的动脉粥样硬化本质。共有1184名参与者（45至84岁）接受了标记心脏磁共振成像检查。通过分析左前降支（LAD）、回旋支（LCX）和右冠状动脉（RCA）区域对应的区域中收缩期圆周应变峰值（Ecc）来量化局部LV功能。使用多元线性回归研究危险因素与应变之间的关联。
结果
较高的舒张压（DBP）与较低的Ecc相关（p≤0.002）。DBP<80、80至84、85至89和≥90mmHg的参与者在LAD区域的Ecc分别为-15.6%、-14.8%、-14.2%和-13.7%（p<0.001）。在其他区域以及多变量分析后也记录到了类似结果。与不吸烟者相比，吸烟者在LAD和RCA区域的Ecc较低。此外，观察到以包年衡量的吸烟量与通过Ecc评估的局部LV功能障碍之间存在剂量反应关系（在LAD和RCA区域p≤0.01）。最后，舒张期高血压与吸烟相结合与局部LV功能的更大降低相关。
结论
在无症状个体中，较高的舒张压和吸烟与局部LV功能降低相关。
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