从青年到中年期间的累积血压与左心房重构和三维超声心动图评估的亚临床功能障碍相关：来自年轻人冠状动脉风险发展研究的前瞻性事后分析。
Cumulative blood pressure from early adulthood to middle age is associated with left atrial remodelling and subclinical dysfunction assessed by three-dimensional echocardiography: a prospective post hoc analysis from the coronary artery risk development in young adults study.
机构信息
Division of Cardiology, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, 600 N. Wolfe Street, Blalock 524, Baltimore, MD, USA.
Department of Medicine, Federal University of Sao Francisco Valley, Av. Jose de Sa Manicoba, S/N, Centro, Petrolina, PE, Brazil.
出版信息
Eur Heart J Cardiovasc Imaging. 2018 Sep 1;19(9):977-984. doi: 10.1093/ehjci/jey086.
AIMS
To evaluate the association of cumulative blood pressure (BP) from young adulthood to middle age with left atrial (LA) structure/function as assessed by three-dimensional echocardiography (3DE) in a large longitudinal bi-racial population study.
METHODS AND RESULTS
We conducted a prospective post hoc analysis of individuals enrolled at the Coronary Artery Risk Development in Young Adults, which is a multi-centre bi-racial cohort with 30 years of follow-up. Cumulative systolic and diastolic BP levels were defined by summing the product of average millimetres of mercury and the years between each two consecutive clinic visits over 30 years of follow-up. Multivariable linear regression analyses were used to assess the relationship between cumulative systolic and diastolic BP with 3DE LA structure and function, adjusting for demographics and traditional cardiovascular risk factors. A total of 1033 participants were included, mean age was 55.4 ± 3.5 years, 55.2% women, 43.9% blacks. Cumulative systolic BP had stronger correlations than cumulative diastolic BP. Higher cumulative systolic BP was independently associated with higher 3D LA volumes: maximum (β = 1.74, P = 0.004), pre-atrial contraction (β = 1.87, P < 0.001), minimum (β = 0.76, P = 0.04), total emptying (β = 0.98, P = 0.006), active emptying (β = 1.12, P < 0.001), and lower magnitude 3D LA early diastolic strain rate (β = 0.05, P = 0.02). Higher cumulative diastolic BP was independently associated with higher 3D LA active emptying volume (β = 0.66, P = 0.002), lower magnitude 3D LA early diastolic strain rate (β = 0.05, P = 0.004), and higher magnitude 3D LA late diastolic strain rate (β = -0.04, P = 0.05).
CONCLUSION
Higher cumulative BP from early adulthood throughout middle age was associated with adverse LA remodelling evaluated by 3D echocardiography.
目的
在一项大型的纵向双种族人群研究中，评估从青年到中年期间累积血压（BP）与通过三维超声心动图（3DE）评估的左心房（LA）结构/功能之间的关联。
方法和结果
我们对参加冠状动脉风险发展在年轻人中的个体进行了前瞻性的事后分析，这是一个具有 30 年随访的多中心双种族队列。累积收缩压和舒张压水平通过将 30 年随访期间每两次连续就诊之间的平均毫米汞柱与年数的乘积相加来定义。使用多变量线性回归分析来评估累积收缩压和舒张压与 3DE LA 结构和功能之间的关系，调整了人口统计学和传统心血管危险因素。共纳入 1033 名参与者，平均年龄为 55.4±3.5 岁，女性占 55.2%，黑人占 43.9%。累积收缩压的相关性强于累积舒张压。较高的累积收缩压与较高的 3D LA 容积独立相关：最大容积（β=1.74，P=0.004）、心房收缩前容积（β=1.87，P<0.001）、最小容积（β=0.76，P=0.04）、总排空容积（β=0.98，P=0.006）、主动排空容积（β=1.12，P<0.001）和较低的 3D LA 早期舒张应变率（β=0.05，P=0.02）。较高的累积舒张压与较高的 3D LA 主动排空容积（β=0.66，P=0.002）、较低的 3D LA 早期舒张应变率（β=0.05，P=0.004）和较高的 3D LA 晚期舒张应变率（β=-0.04，P=0.05）独立相关。
结论
从青年到中年期间较高的累积血压与通过 3D 超声心动图评估的不良 LA 重塑有关。
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