Department of Medicine, Columbia University, New York City, New York.
Department of Biostatistics, Columbia University, New York City, New York.
JACC Cardiovasc Imaging. 2017 Sep;10(9):976-985. doi: 10.1016/j.jcmg.2016.07.015. Epub 2016 Dec 21.
This study sought to assess the prevalence and prognostic value of abnormalities in left atrial (LA) phasic volumes and reservoir function in a community cohort.
LA enlargement is associated with adverse cardiovascular outcomes. Real-time 3-dimensional (RT3D) echocardiography allows assessment of LA phasic volumes and reservoir function. However, there is a paucity of data regarding normal values, clinical correlates, and prognostic value of RT3D echocardiography-derived LA phasic volumes and reservoir function, especially in the elderly, a subgroup at high risk for cardiovascular events.
Left atrial maximum volume (LAVi), minimum volume (LAVi), and reservoir function assessed as emptying volume (LAEV), emptying fraction (LAEF), and expansion index (LAEI), were measured by RT3D echocardiography in participants from a community-based cohort study. Cut-off values for LA phasic volumes were derived from a healthy subgroup of participants free of cardiovascular disease and risk factors (n = 142; 66 ± 9 years of age; 55% women). Annual follow-up examinations were performed for cardiovascular outcomes (myocardial infarction, ischemic stroke, and vascular death).
The cohort included 706 participants (71 ± 9 years of age; 59% women). LAVi and LAVi were not associated with age in the healthy subgroup but progressively increased with age in the entire cohort (p < 0.001). During a median follow-up of 7 years (minimum 0.06, maximum 9.5 years), 78 cardiovascular events occurred. In univariate analysis, LAVi, LAVi, and reservoir function parameters were significantly associated with outcome. In multivariate analysis, LAVi ≥20.5 ml/m (adjusted hazard ratio [aHR]: 1.79; 95% confidence interval [CI]:1.02 to 3.16) and LAEV ≤5.7 ml/m (aHR: 1.98; 95% CI: 1.02 to 3.85) remained significantly associated with events. LAVi and LA reservoir function showed incremental prognostic value over that of LAVi.
LA phasic volumes and reservoir functions assessed by RT3D echocardiography were strong independent predictors of cardiovascular events in a community-based elderly cohort. LAVi and reservoir function assessment may improve cardiovascular outcome prediction over LAVi.
本研究旨在评估社区队列中左心房（LA）相容积和储器功能异常的发生率及其预后价值。
LA 扩大与不良心血管结局相关。实时三维（RT3D）超声心动图可评估 LA 相容积和储器功能。然而，关于 RT3D 超声心动图衍生的 LA 相容积和储器功能的正常值、临床相关性和预后价值的数据很少，特别是在老年人这一发生心血管事件风险较高的亚组中。
通过 RT3D 超声心动图测量来自社区队列研究的参与者的左心房最大容积（LAVi）、最小容积（LAVi）和储器功能，作为排空容积（LAEV）、排空分数（LAEF）和扩张指数（LAEI）。从无心血管疾病和危险因素的健康亚组（n=142；66±9 岁；55%为女性）中得出 LA 相容积的截断值。对心血管结局（心肌梗死、缺血性卒中和血管性死亡）进行年度随访检查。
该队列包括 706 名参与者（71±9 岁；59%为女性）。健康亚组中，LAVi 和 LAVi 与年龄无关，但在整个队列中随年龄逐渐增加（p<0.001）。中位随访 7 年（最短 0.06 年，最长 9.5 年）期间，发生 78 例心血管事件。在单变量分析中，LAVi、LAVi 和储器功能参数与结局显著相关。在多变量分析中，LAVi≥20.5 ml/m（调整后的危险比[aHR]：1.79；95%置信区间[CI]：1.02 至 3.16）和 LAEV≤5.7 ml/m（aHR：1.98；95% CI：1.02 至 3.85）仍与事件显著相关。LAVi 和 LA 储器功能较 LAVi 具有更强的预后预测价值。
RT3D 超声心动图评估的 LA 相容积和储器功能是社区老年人队列中心血管事件的独立强预测因子。LAVi 和储器功能评估可能比 LAVi 更能改善心血管结局预测。
