左心房结构和功能与糖尿病患者心血管疾病事件的关系：来自动脉粥样硬化多民族研究（MESA）的结果。
Association of left atrial structure and function and incident cardiovascular disease in patients with diabetes mellitus: results from multi-ethnic study of atherosclerosis (MESA).
机构信息
Department of Medicine, The Johns Hopkins University, 600 North Wolfe Street, MD 21287, Baltimore, USA.
Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY 10461, New York, USA.
出版信息
Eur Heart J Cardiovasc Imaging. 2017 Oct 1;18(10):1138-1144. doi: 10.1093/ehjci/jew332.
AIMS
Diabetes mellitus (DM) is associated with the development of cardiovascular disease (CVD). Morphological changes in the left atrium (LA) may appear before symptoms. We aimed to investigate the association between cardiac magnetic resonance imaging (CMR) measured LA structure and function and incident CVD in asymptomatic individuals with DM.
METHODS AND RESULTS
Tissue tracking CMR was used to measure LA size and phasic function (emptying fractions and strain) on all 536 Multi-Ethnic Study of Atherosclerosis (MESA) participants with DM and available CMR at baseline in 2000-2002. At the time of enrolment, all participants were free of clinically recognized CVD, which was defined as MI, resuscitated cardiac arrest, angina, stroke, heart failure, and atrial fibrillation. Cox regression was used to assess the association of LA parameters with incident CVD adjusted for traditional cardiovascular risk factors, LV mass, NT Pro-BNP and maximum LA volume. Kaplan-Meier curves, adjusted for traditional risk factors, were generated for each LA measurement for the 25% of participants with the most abnormal values versus the remaining 75%. After a mean follow up of 11.4 ± 3.4 years, 141 individuals developed CVD. Individuals with incident CVD (mean age 66 years, 66% male vs. mean age 64 years, 50% male) had larger maximum and minimum LA volume index (LAVI) (32.1 vs. 26.8 mm3/m2; 19.4 vs. 14.2 mm3/m2 respectively, P < 0.001 for both), and lower total, passive, and active EF than those without CVD (P < 0.01 for all). In the fully adjusted model, there was a significant association of minimum LAVI, LA total EF, LA passive EF and LA active EF with incident CVD (HR 1.12 per mm3/m2, P < 0.001; HR 0.95 per %, P < 0.001; HR 0.97 per %, P = 0.021; HR 0.98 per %, P < 0.027, respectively).
CONCLUSIONS
CMR measured LA minimum volume and LA function as measured by emptying fraction are predictive of CVD in a diabetic multi-ethnic population free of any clinically recognized CVD at baseline.
目的
糖尿病（DM）与心血管疾病（CVD）的发展有关。左心房（LA）的形态变化可能在出现症状之前出现。我们旨在研究无症状 DM 个体中 CMR 测量的 LA 结构和功能与 CVD 事件之间的相关性。
方法和结果
使用组织跟踪 CMR 测量 536 名多民族动脉粥样硬化研究（MESA）参与者中具有 DM 且在 2000-2002 年基线时有可用 CMR 的 LA 大小和时相功能（排空分数和应变）。在入组时，所有参与者均无临床公认的 CVD，CVD 定义为 MI、心脏复苏性骤停、心绞痛、中风、心力衰竭和心房颤动。Cox 回归用于评估 LA 参数与 CVD 事件的相关性，该参数经过传统心血管危险因素、LV 质量、NT Pro-BNP 和最大 LA 容积调整。为了调整传统危险因素，为每个 LA 测量生成 Kaplan-Meier 曲线，对于值最异常的 25%参与者与其余 75%参与者。平均随访 11.4±3.4 年后，141 人发生 CVD。发生 CVD 的个体（平均年龄 66 岁，66%男性与平均年龄 64 岁，50%男性）的最大和最小 LA 容积指数（LAVI）较大（32.1 与 26.8 mm3/m2；19.4 与 14.2 mm3/m2，均 P<0.001），总、被动和主动 EF 较低（所有 P<0.01）。在完全调整的模型中，最小 LAVI、LA 总 EF、LA 被动 EF 和 LA 主动 EF 与 CVD 事件显著相关（每增加 1mm3/m2 的 HR 为 1.12，P<0.001；每增加 1%的 HR 为 0.95，P<0.001；每增加 1%的 HR 为 0.97，P=0.021；每增加 1%的 HR 为 0.98，P<0.027）。
结论
在基线时无任何临床公认的 CVD 的糖尿病多民族人群中，CMR 测量的 LA 最小容积和排空分数测量的 LA 功能可预测 CVD。
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