Cho In-Jeong, Chang Hyuk-Jae, Cho Iksung, Heo Ran, Lee Sang-Eun, Shim Chi Young, Hong Geu-Ru, Chung Namsik
Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea
J Am Heart Assoc. 2016 Apr 22;5(4):e003131. doi: 10.1161/JAHA.115.003131.
The structure of the aorta is considered to influence exercise systolic blood pressure (SBP) response, which, in turn, might impact upon adverse outcomes. The current study sought to investigate the relationship of aortic calcification and exercise SBP with adverse outcomes among elderly individuals.
We retrospectively reviewed 702 elderly individuals (>65 years of age) without obstructive coronary artery disease (CAD; luminal stenosis <50%) who underwent coronary computed tomography (CT) and exercise treadmill testing. ΔSBPstage2 and ΔSBPpeak were defined as the difference in systolic blood pressure (SBP) between rest and stage 2 or peak exercise, respectively. Thoracic aortic calcium score (TACS) and coronary artery calcium score (CACS) were measured using CT scanning procedures. The primary endpoints were defined as all-cause death, admission for heart failure, obstructive CAD requiring coronary intervention, and stroke. In multivariable models, ΔSBPstage2 and ΔSBPpeak were positively related with log(TACS+1), even after adjusting for various clinical variables, baseline SBP, and CACS (P<0.001). During a median follow-up period of 65 months, there were 59 events (8.4%). In a multivariate Cox regression model, independent predictors for all events were age (hazard ratio [HR], 1.12; 95% CI, 1.05-1.19; P<0.001), dyslipidemia (HR, 1.96; 95% CI, 1.14-3.37; P=0.015), and the 4th quartile of TACS (HR, 1.24; 95% CI, 1.03-1.49; P=0.024). Among individual events, the 4th quartile of TACS was the only independent predictor for stroke (HR, 2.15; 95% CI, 1.09-5.13; P=0.044), whereas CACS ≥400 mm(3) was an independent predictor for obstructive CAD requiring intervention (HR, 7.04; 95% CI, 1.58-31.36; P=0.010).
Aortic calcification was related to SBP response during exercise and was an independent predictor for outcomes, especially stroke, regardless of resting SBP or CACS.
主动脉结构被认为会影响运动收缩压（SBP）反应，而这反过来可能会影响不良结局。本研究旨在调查老年个体中主动脉钙化与运动SBP和不良结局之间的关系。
我们回顾性分析了702例年龄大于65岁、无阻塞性冠状动脉疾病（CAD；管腔狭窄<50%）的老年个体，这些个体均接受了冠状动脉计算机断层扫描（CT）和运动平板试验。ΔSBPstage2和ΔSBPpeak分别定义为静息状态与运动第二阶段或运动峰值时收缩压（SBP）的差值。采用CT扫描程序测量胸主动脉钙化评分（TACS）和冠状动脉钙化评分（CACS）。主要终点定义为全因死亡、因心力衰竭入院、需要冠状动脉介入治疗的阻塞性CAD以及中风。在多变量模型中，即使在调整了各种临床变量、基线SBP和CACS后，ΔSBPstage2和ΔSBPpeak仍与log（TACS + 1）呈正相关（P<0.001）。在中位随访期65个月期间，共发生59起事件（8.4%）。在多变量Cox回归模型中，所有事件的独立预测因素为年龄（风险比[HR]，1.12；95%CI，1.05 - 1.19；P<0.001）、血脂异常（HR，1.96；95%CI，1.14 - 3.37；P = 0.015）以及TACS的第4四分位数（HR，1.24；95%CI，1.03 - 1.49；P = 0.024）。在个体事件中，TACS的第4四分位数是中风的唯一独立预测因素（HR，2.15；95%CI，1.09 - 5.13；P = 0.044），而CACS≥400 mm(3)是需要干预的阻塞性CAD的独立预测因素（HR，7.04；95%CI，1.58 - 31.36；P = 0.010）。
主动脉钙化与运动期间的SBP反应相关，并且是结局的独立预测因素，尤其是中风，无论静息SBP或CACS如何。
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