Losi Maria-Angela, Izzo Raffaele, Mancusi Costantino, Wang Wenyu, Roman Mary J, Lee Elisa T, Howard Barbara V, Devereux Richard B, de Simone Giovanni
Hypertension Research Center, University Federico II of Naples, I-80131 Naples, Italy.
Department of Advanced Biomedical Sciences, University Federico II of Naples, I-80131 Naples, Italy.
J Clin Med. 2019 Jul 17;8(7):1044. doi: 10.3390/jcm8071044.
An estimation of myocardial mechano-energetic efficiency (MEE) per unit of left ventricular (LV) mass (MEEi) can significantly predict composite cardiovascular (CV) events in treated hypertensive patients with normal ejection fraction (EF), after adjustment for LV hypertrophy (LVH). We have tested whether MEEi predicts incident heart failure (HF), after adjustment for LVH, in the population-based cohort of a "Strong Heart Study" (SHS) with normal EF. We included 1,912 SHS participants (age 59 ± 8 years; 64% women) with preserved EF (≥50%) and without prevalent CV disease. MEE was estimated as the ratio of stroke work to the "double product" of heart rate times systolic blood pressure. MEEi was calculated as MEE/LV mass, and analyzed in quartiles. During a follow-up study of 9.2 ± 2.3 years, 126 participants developed HF (7%). HF was preceded by acute myocardial infarction (AMI) in 94 participants. A Kaplan-Meier plot, in quartiles of MEEi, demonstrated significant differences, substantially due to the deviation of the lowest quartile ( < 0.0001). Using AMI as a competing risk event, sequential models of Cox regression for incident HF (including significant confounders), demonstrated that low MEEi predicted incident HF not due to AMI ( = 0.026), after adjustment for significant effect of age, LVH, prolonged LV relaxation, diabetes, and smoking habits with negligible effects for sex, hypertension, antihypertensive therapy, obesity, and hyperlipemia. Low LV mechano-energetic efficiency per unit of LVM, is a predictor of incident, non-AMI related, HF in subjects with initially normal EF.
在对左心室肥厚（LVH）进行校正后，每单位左心室（LV）质量的心肌机械能量效率（MEE）估计值（MEEi）能够显著预测射血分数（EF）正常的高血压患者的复合心血管（CV）事件。我们在“强心研究”（SHS）中以EF正常的人群为队列，测试了在对LVH进行校正后，MEEi是否能预测新发心力衰竭（HF）。我们纳入了1912名SHS参与者（年龄59±8岁；64%为女性），其EF保留（≥50%）且无既往CV疾病。MEE被估计为每搏功与心率乘以收缩压的“双乘积”的比值。MEEi计算为MEE/LV质量，并按四分位数进行分析。在9.2±2.3年的随访研究中，126名参与者发生了HF（7%）。94名参与者在发生HF之前有急性心肌梗死（AMI）。按MEEi四分位数绘制的Kaplan-Meier曲线显示出显著差异，主要是由于最低四分位数的偏离（<0.0001）。将AMI作为竞争风险事件，对新发HF的Cox回归序贯模型（包括显著混杂因素）显示，在对年龄、LVH、左心室舒张期延长、糖尿病和吸烟习惯的显著影响进行校正后，低MEEi可预测非AMI所致的新发HF（P=0.026），而性别、高血压、抗高血压治疗、肥胖和高脂血症的影响可忽略不计。每单位LV质量的低左心室机械能量效率是EF最初正常的受试者中非AMI相关新发HF的预测指标。
