Turkbey Evrim B, Nacif Marcelo S, Guo Mengye, McClelland Robyn L, Teixeira Patricia B R P, Bild Diane E, Barr R Graham, Shea Steven, Post Wendy, Burke Gregory, Budoff Matthew J, Folsom Aaron R, Liu Chia-Ying, Lima João A, Bluemke David A
Radiology and Imaging Sciences, National Institutes of Health Clinical Center, National Institute of Biomedical Imaging and Bioengineering, Bethesda, Maryland2Radiology and Radiological Science, Johns Hopkins University, Baltimore, Maryland.
Radiology and Imaging Sciences, National Institutes of Health Clinical Center, National Institute of Biomedical Imaging and Bioengineering, Bethesda, Maryland.
JAMA. 2015 Nov 10;314(18):1945-54. doi: 10.1001/jama.2015.14849.
Myocardial scarring leads to cardiac dysfunction and poor prognosis. The prevalence of and factors associated with unrecognized myocardial infarction and scar have not been previously defined using contemporary methods in a multiethnic US population.
To determine prevalence of and factors associated with myocardial scar in middle- and older-aged individuals in the United States.
DESIGN, SETTING, AND PARTICIPANTS: The Multi-Ethnic Study of Atherosclerosis (MESA) study is a population-based cohort in the United States. Participants were aged 45 through 84 years and free of clinical cardiovascular disease (CVD) at baseline in 2000-2002. In the 10th year examination (2010-2012), 1840 participants underwent cardiac magnetic resonance (CMR) imaging with gadolinium to detect myocardial scar. Cardiovascular disease risk factors and coronary artery calcium (CAC) scores were measured at baseline and year 10. Logistic regression models were used to estimate adjusted odds ratios (ORs) for myocardial scar.
Cardiovascular risk factors, CAC scores, left ventricle size and function, and carotid intima-media thickness.
Myocardial scar detected by CMR imaging.
Of 1840 participants (mean [SD] age, 68 [9] years, 52% men), 146 (7.9%) had myocardial scars, of which 114 (78%) were undetected by electrocardiogram or by clinical adjudication. In adjusted models, age, male sex, body mass index, hypertension, and current smoking at baseline were associated with myocardial scar at year 10. The OR per 8.9-year increment was 1.61 (95% CI, 1.36-1.91; P < .001); for men vs women: OR, 5.76 (95% CI, 3.61-9.17; P < .001); per 4.8-SD body mass index: OR, 1.32 (95% CI, 1.09-1.61, P = .005); for hypertension: OR, 1.61 (95% CI, 1.12-2.30; P = .009); and for current vs never smokers: 2.00 (95% CI, 1.22-3.28; P = .006). Age-, sex-, and ethnicity-adjusted CAC scores at baseline were also associated with myocardial scar at year 10. Compared with a CAC score of 0, the OR for scores from 1 through 99 was 2.4 (95% CI, 1.5-3.9); from 100 through 399, 3.0 (95% CI, 1.7-5.1), and 400 or higher, 3.3 (95% CI, 1.7-6.1) (P ≤ .001). The CAC score significantly added to the association of myocardial scar with age, sex, race/ethnicity, and traditional CVD risk factors (C statistic, 0.81 with CAC vs 0.79 without CAC, P = .01).
The prevalence of myocardial scars in a US community-based multiethnic cohort was 7.9%, of which 78% were unrecognized by electrocardiography or clinical evaluation. Further studies are needed to understand the clinical consequences of these undetected scars.
心肌瘢痕会导致心脏功能障碍和预后不良。此前尚未采用当代方法在美国多民族人群中确定未被识别的心肌梗死和瘢痕的患病率及相关因素。
确定美国中老年人群中心肌瘢痕的患病率及相关因素。
设计、地点和参与者：动脉粥样硬化多民族研究（MESA）是一项基于美国人群的队列研究。参与者年龄在45至84岁之间，在2000 - 2002年基线时无临床心血管疾病（CVD）。在第10年检查（2010 - 2012年）时，1840名参与者接受了钆增强心脏磁共振（CMR）成像以检测心肌瘢痕。在基线和第10年测量心血管疾病危险因素和冠状动脉钙化（CAC）评分。使用逻辑回归模型估计心肌瘢痕的调整优势比（OR）。
心血管危险因素、CAC评分、左心室大小和功能以及颈动脉内膜中层厚度。
通过CMR成像检测到的心肌瘢痕。
在1840名参与者（平均[标准差]年龄，68[9]岁，52%为男性）中，146名（7.9%）有心肌瘢痕，其中114名（78%）通过心电图或临床判定未被检测到。在调整模型中，基线时的年龄、男性性别、体重指数、高血压和当前吸烟与第10年的心肌瘢痕相关。每增加8.9岁的OR为1.61（95%置信区间，1.36 - 1.91；P <.001）；男性与女性相比：OR为5.76（95%置信区间，3.61 - 9.17；P <.001）；每增加4.8个标准差的体重指数：OR为1.32（95%置信区间，1.09 - 1.61，P =.005）；高血压患者：OR为1.61（95%置信区间，1.12 - 2.30；P =.009）；当前吸烟者与从不吸烟者相比：2.00（95%置信区间，1.22 - 3.28；P =.006）。基线时经年龄、性别和种族调整后的CAC评分也与第10年的心肌瘢痕相关。与CAC评分为0相比，评分为1至99的OR为2.4（95%置信区间，1.5 - 3.9）；100至399的OR为3.0（95%置信区间，1.7 - 5.1），400及以上的OR为3.3（95%置信区间，1.7 - 6.1）（P ≤.001）。CAC评分显著增加了心肌瘢痕与年龄、性别、种族/民族和传统CVD危险因素之间的关联（C统计量，有CAC时为0.81，无CAC时为0.79，P =.01）。
在美国一个以社区为基础的多民族队列中，心肌瘢痕的患病率为7.9%，其中78%通过心电图或临床评估未被识别。需要进一步研究以了解这些未被检测到的瘢痕的临床后果。
