Department of Radiology, Keck School of Medicine, University of Southern California, LAC+USC Medical Center GH 3566, Los Angeles, CA 90033, USA.
Radiology. 2010 Oct;257(1):64-70. doi: 10.1148/radiol.10091868. Epub 2010 Aug 16.
To evaluate subclinical atherosclerosis measured by using coronary artery calcium (CAC) as a predictor of future left ventricular (LV) systolic and diastolic function in asymptomatic elderly participants.
The institutional review boards of the University of Southern California and the Harbor University of California Los Angeles Research and Education Institute (where the South Bay Heart Watch study was initially conducted) approved this HIPAA-compliant study of 386 participants (mean age, 75.2 years) from among the original 1461 participants in the longitudinal South Bay Heart Watch prospective investigation of subclinical atherosclerosis. CAC at computed tomography was correlated with LV ejection fraction (LVEF), regional wall motion abnormalities (RWMAs), and peak filling rate (PFR) assessed a mean of 11.4 years ± 0.6 (standard deviation) later with cardiac magnetic resonance imaging. Analysis of variance and covariance testing was performed with the Wald test, testing for trends across the CAC groups. Covariates included age, level of total cholesterol, level of high-density lipoprotein cholesterol, systolic blood pressure, use of lipid-lowering medication, and smoking status.
Mean LVEF was 60.3% ± 9.9, with 11 (2.8%) of 386 participants having an LVEF of less than 40%. Forty-six (11.9%) of 386 participants had RWMAs. Higher CAC scores were associated with slightly lower LVEF (P for trend = .04) and a greater percentage of participants with decreased PFR (P for trend = .47) and RWMAs (P for trend = .01). After age- and risk factor-adjustment, only RWMA (P = .05) was associated with higher CAC. RWMAs were associated with significantly (P < .001) lower mean LVEF and PFR. Nineteen (41%) of 46 participants with RWMAs had documented Q-wave myocardial infarction, and three (7%) underwent coronary revascularization. CAC scores of 100 or greater were associated with a 2.2-fold (95% confidence interval: 1.30, 3.75) increase in RWMA (P < .001).
Subclinical atherosclerosis assessed by using CAC is associated with an increased future likelihood of RWMA, as a marker of previous and possible subclinical coronary artery disease.
通过冠状动脉钙（CAC）评估亚临床动脉粥样硬化，预测无症状老年参与者未来的左心室（LV）收缩和舒张功能。
南加州大学和 Harbor University of California Los Angeles Research and Education Institute（最初进行 South Bay Heart Watch 研究的地方）的机构审查委员会批准了这项 HIPAA 合规性研究，该研究纳入了来自于最初的 1461 名参与者中的 386 名参与者（平均年龄 75.2 岁），这些参与者来自于 South Bay Heart Watch 前瞻性亚临床动脉粥样硬化研究。使用计算机断层扫描（CT）测量 CAC，并与平均 11.4 年（±0.6）后通过心脏磁共振成像评估的 LV 射血分数（LVEF）、局部壁运动异常（RWMAs）和峰值充盈率（PFR）相关。采用方差分析和协方差检验，采用 Wald 检验对 CAC 组进行趋势检验。协变量包括年龄、总胆固醇水平、高密度脂蛋白胆固醇水平、收缩压、降脂药物使用情况和吸烟状况。
平均 LVEF 为 60.3%±9.9%，386 名参与者中有 11 名（2.8%）的 LVEF 低于 40%。386 名参与者中有 46 名（11.9%）存在 RWMAs。CAC 评分较高与稍低的 LVEF（趋势 P =.04）和更多的 PFR 降低百分比（趋势 P =.47）以及 RWMAs（趋势 P =.01）相关。在年龄和危险因素调整后，只有 RWMAs（P =.05）与较高的 CAC 相关。RWMAs 与显著（P <.001）较低的平均 LVEF 和 PFR 相关。46 名存在 RWMAs 的参与者中有 19 名（41%）有记录的 Q 波心肌梗死，3 名（7%）接受了冠状动脉血运重建。CAC 评分≥100 与 RWMAs 的 2.2 倍（95%置信区间：1.30，3.75）增加相关（P <.001）。
使用 CAC 评估的亚临床动脉粥样硬化与未来发生 RWMAs 的可能性增加相关，RWMAs 是先前和可能的冠状动脉疾病的标志物。
