Leary Peter J, Tedford Ryan J, Bluemke David A, Bristow Michael R, Heckbert Susan R, Kawut Steven M, Krieger Eric V, Lima Joao A, Masri Carolina S, Ralph David D, Shea Steven, Weiss Noel S, Kronmal Richard A
Department of Medicine, University of Washington, Seattle, Washington.
Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland.
J Am Coll Cardiol. 2016 Apr 5;67(13):1544-1552. doi: 10.1016/j.jacc.2016.01.045.
Myocardial H2 receptor activation may promote cardiac fibrosis and apoptosis in pre-clinical models and histamine H2 receptor antagonist (H2RA) use may improve symptoms in participants with heart failure (HF); however, relationships between H2RA use, incident HF, and longitudinal change in left ventricular (LV) morphology are not known.
This study sought to determine whether H2RA use is associated with incident HF and change in LV morphology over time.
We included 6,378 men and women from MESA (Multi-Ethnic Study of Atherosclerosis), a multicenter prospective observational cohort of participants without cardiovascular disease at baseline. Cox proportional hazards were used to estimate the association between H2RA use and incident HF in adjusted models. In participants with cardiac magnetic resonance imaging, associations between H2RA use, baseline LV morphology (n = 4,691), and longitudinal change in the LV (n = 2,806) were estimated using linear regression.
H2RAs were used by 313 participants but not by the other 6,065 individuals. During a median follow-up of 11.2 years, 236 participants developed HF. In adjusted models, baseline H2RA use relative to nonuse was associated with 62% lower risk for incident HF (p = 0.02). H2RA use was associated with preserved stroke volume, LV end-diastolic volume, and mass/volume ratio as measured by cardiac magnetic resonance imaging over approximately 10 years (all p < 0.05). There were no associations between H2RA use and LV mass or ejection fraction.
H2RA use was associated with reduced risk for incident HF. Left heart morphology over time suggests less age-related change in H2RA users. These associations suggest histamine signaling may be important in the pathogenesis of HF. (Multi-Ethnic Study of Atherosclerosis [MESA]; NCT00005487).
在临床前模型中，心肌H2受体激活可能促进心脏纤维化和细胞凋亡，使用组胺H2受体拮抗剂（H2RA）可能改善心力衰竭（HF）患者的症状；然而，H2RA的使用、新发HF以及左心室（LV）形态的纵向变化之间的关系尚不清楚。
本研究旨在确定H2RA的使用是否与新发HF以及LV形态随时间的变化相关。
我们纳入了来自动脉粥样硬化多族裔研究（MESA）的6378名男性和女性，这是一个多中心前瞻性观察队列，基线时无心血管疾病。在调整模型中，使用Cox比例风险模型估计H2RA使用与新发HF之间的关联。在接受心脏磁共振成像的参与者中，使用线性回归估计H2RA使用、基线LV形态（n = 4691）和LV的纵向变化（n = 2806）之间的关联。
313名参与者使用了H2RA，其他6065人未使用。在中位随访11.2年期间，236名参与者发生了HF。在调整模型中，与未使用相比，基线时使用H2RA与新发HF风险降低62%相关（p = 0.02）。通过心脏磁共振成像测量，在大约10年的时间里，使用H2RA与每搏输出量、LV舒张末期容积和质量/容积比的保留相关（所有p < 0.05）。H2RA使用与LV质量或射血分数之间无关联。
使用H2RA与新发HF风险降低相关。随着时间的推移，左心形态表明H2RA使用者与年龄相关的变化较小。这些关联表明组胺信号传导可能在HF的发病机制中起重要作用。（动脉粥样硬化多族裔研究[MESA]；NCT00005487）
