二尖瓣环钙化对多民族社区心血管事件的影响：北曼哈顿研究
Impact of mitral annular calcification on cardiovascular events in a multiethnic community: the Northern Manhattan Study.
作者信息
Kohsaka Shun, Jin Zhezhen, Rundek Tatjana, Boden-Albala Bernadette, Homma Shunichi, Sacco Ralph L, Di Tullio Marco R
机构信息
Division of Cardiology, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA.
出版信息
JACC Cardiovasc Imaging. 2008 Sep;1(5):617-23. doi: 10.1016/j.jcmg.2008.07.006.
OBJECTIVES
We sought to determine the magnitude of the association between mitral annular calcification (MAC) and vascular events in a multiethnic cohort.
BACKGROUND
Mitral annular calcification is common in the elderly and is associated with atherosclerotic risk factors. Its impact on the risk of cardiovascular events is controversial.
METHODS
The study cohort consisted of 1,955 subjects, ages >or=40 years, and free of prior myocardial infarction (MI) and ischemic stroke (IS). Mitral annular calcification was assessed by transthoracic 2-dimensional echocardiography. The association between MAC and MI, IS, and vascular death (VD) was examined by Cox proportional hazard models with adjustment for established cardiovascular risk factors. The effect of MAC thickness was also analyzed.
RESULTS
The mean age of the cohort was 68.0 +/- 9.7 years and the majority of subjects were Hispanics (56.8%). A total of 519 subjects (26.6%) had MAC. Of 498 patients with MAC thickness measurements available, 253 (13.1%) had mild to moderate MAC (1 to 4 mm) and 245 (12.7%) severe MAC (>4 mm). During a mean follow-up of 7.4 +/- 2.5 years, MI occurred in 100 (5.1%) subjects, IS in 104 (5.3%) subjects, and VD in 155 (8.0%) subjects. After adjustment for other cardiovascular risk factors, MAC was associated with an increased risk of MI (adjusted hazard ratio [HR]: 1.75; 95% confidence interval [CI]: 1.13 to 2.69, p = 0.011) and VD (adjusted HR: 1.53; 95% CI: 1.09 to 2.15, p = 0.015), but not IS (adjusted HR: 1.34; 95% CI: 0.87 to 2.05, p = 0.18). Further analysis revealed that the impact of MAC was related to its thickness, with MAC >4 mm being a strong and independent predictor of MI (adjusted HR: 1.89; 95% CI: 1.13 to 3.17, p = 0.008) and VD (adjusted HR: 1.81; 95% CI: 1.21 to 2.72, p = 0.002), and showing borderline association with IS (adjusted HR: 1.59; 95% CI: 0.95 to 2.67, p = 0.084).
CONCLUSIONS
In this multiethnic cohort, MAC was a strong and independent predictor of cardiovascular events, especially MI and VD. The risk increase was directly related to MAC severity.
目的
我们试图在一个多民族队列中确定二尖瓣环钙化（MAC）与血管事件之间关联的程度。
背景
二尖瓣环钙化在老年人中很常见，且与动脉粥样硬化危险因素相关。其对心血管事件风险的影响存在争议。
方法
研究队列由1955名年龄≥40岁、无既往心肌梗死（MI）和缺血性中风（IS）的受试者组成。通过经胸二维超声心动图评估二尖瓣环钙化情况。采用Cox比例风险模型，在调整既定心血管危险因素的情况下，研究MAC与MI、IS和血管性死亡（VD）之间的关联。还分析了MAC厚度的影响。
结果
队列的平均年龄为68.0±9.7岁，大多数受试者为西班牙裔（56.8%）。共有519名受试者（26.6%）存在MAC。在498名有MAC厚度测量值的患者中，253名（13.1%）有轻度至中度MAC（1至4毫米），245名（12.7%）有重度MAC（>4毫米）。在平均7.4±2.5年的随访期间，100名（5.1%）受试者发生MI，104名（5.3%）受试者发生IS，155名（8.0%）受试者发生VD。在调整其他心血管危险因素后，MAC与MI风险增加相关（调整后风险比[HR]：1.75；95%置信区间[CI]：1.13至2.69，p = 0.011）和VD风险增加相关（调整后HR：1.53；95%CI：1.09至2.15，p = 0.015），但与IS无关（调整后HR：1.34；95%CI：0.87至2.05，p = 0.18）。进一步分析显示，MAC的影响与其厚度有关，MAC>4毫米是MI（调整后HR：1.89；95%CI：1.13至3.17，p = 0.008）和VD（调整后HR：1.81；95%CI：1.21至2.72，p = 0.002）的强有力且独立的预测因素，并与IS存在临界关联（调整后HR：1.59；95%CI：0.95至2.67，p = 0.084）。
结论
在这个多民族队列中
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