Hoang Khiet, Zhao Yanglu, Gardin Julius M, Carnethon Mercedes, Mukamal Ken, Yanez David, Wong Nathan D
Heart Disease Prevention Program, Division of Cardiology, Department of Medicine, University of California, Irvine, Irvine, California.
Department of Medicine, Hackensack University Medical Center, Hackensack, New Jersey.
JACC Cardiovasc Imaging. 2015 Sep;8(9):1007-1015. doi: 10.1016/j.jcmg.2015.04.019. Epub 2015 Aug 26.
The purpose of this study was to examine the prognostic significance of left ventricular (LV) mass for cardiovascular disease (CVD) events in older adults with and without metabolic syndrome (MetS) and diabetes mellitus (DM).
MetS and DM are associated with increased CVD risk, but it is unclear in these groups whether subclinical CVD as shown by increased LV mass improves risk prediction compared to standard risk factors in older individuals.
We studied 3,724 adults (mean 72.4 ± 5.4 years of age, 61.0% female, 4.4% African-American) from the Cardiovascular Health Study who had MetS but not DM or had DM alone or had neither condition. Cox regression was used to examine the association of LV mass, (alone and indexed by height and body surface area [BSA]) as determined by echocardiography, with CVD events, including coronary heart disease (CHD), stroke, heart failure (HF), and CVD death, as well as total mortality. We also assessed the added prediction, discriminative value, and net reclassification improvement (NRI) for clinical utility of LV mass compared to standard risk factors.
Over a mean follow-up of 14.2 ± 6.3 years, 2,180 subjects experienced CVD events, including 986 CVD deaths. After adjustment for age, sex and standard risk factors, LV mass was positively associated with CVD events in those with MetS (hazard ratio [HR]: 1.4, p < 0.001) and without MetS (HR: 1.4, p < 0.001), but not DM (HR: 1.0, p = 0.62), with similar findings for LV mass indexed for height or BSA. Adding LV mass to standard risk factors moderately improved the prediction accuracy in the overall sample and MetS group from changes in C-statistics (p < 0.05). Categorical-free net reclassification improvement increased significantly by 17% to 19% in those with MetS. Findings were comparable for CHD, CVD mortality, and total mortality.
LV mass is associated with increased CVD risk and provides modest added prediction and clinical utility compared to standard risk factors in older persons with and without MetS but not with DM.
本研究旨在探讨左心室（LV）质量对患有和未患有代谢综合征（MetS）及糖尿病（DM）的老年人发生心血管疾病（CVD）事件的预后意义。
MetS和DM与CVD风险增加相关，但在这些人群中，与老年人的标准风险因素相比，LV质量增加所显示的亚临床CVD是否能改善风险预测尚不清楚。
我们对心血管健康研究中的3724名成年人（平均年龄72.4±5.4岁，61.0%为女性，4.4%为非裔美国人）进行了研究，这些人患有MetS但未患DM，或仅患DM，或两者均未患。采用Cox回归分析超声心动图测定的LV质量（单独以及根据身高和体表面积[BSA]进行指数化）与CVD事件（包括冠心病（CHD）、中风、心力衰竭（HF）和CVD死亡）以及总死亡率之间的关联。我们还评估了与标准风险因素相比，LV质量在临床应用中的额外预测价值、鉴别价值和净重新分类改善（NRI）。
在平均14.2±6.3年的随访期内，2180名受试者发生了CVD事件，其中986人死于CVD。在调整年龄、性别和标准风险因素后，LV质量在患有MetS的人群（风险比[HR]：1.4，p<0.001）和未患有MetS的人群（HR：1.4，p<0.001）中与CVD事件呈正相关，但在未患DM的人群中无相关性（HR：1.0，p=0.62），根据身高或BSA指数化的LV质量也有类似结果。将LV质量添加到标准风险因素中，总体样本和MetS组的预测准确性从C统计量的变化来看有适度提高（p<0.05）。在患有MetS的人群中，无类别净重新分类改善显著增加了17%至19%。CHD、CVD死亡率和总死亡率的结果相似。
LV质量与CVD风险增加相关，与患有和未患有MetS但未患DM的老年人的标准风险因素相比，其提供了适度的额外预测价值和临床应用价值。
