小整体心脏容积可预测稳定型胸痛患者的心血管事件：来自 PROMISE 试验的见解。
Small whole heart volume predicts cardiovascular events in patients with stable chest pain: insights from the PROMISE trial.
机构信息
Cardiovascular Imaging Research Center, Massachusetts General Hospital - Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, 02114, USA.
Department of Radiology, Rhön Klinikum - Campus Bad Neustadt, Bad Neustadt an der Saale, Germany.
出版信息
Eur Radiol. 2021 Aug;31(8):6200-6210. doi: 10.1007/s00330-021-07695-2. Epub 2021 Jan 26.
OBJECTIVES
The size of the heart may predict major cardiovascular events (MACE) in patients with stable chest pain. We aimed to evaluate the prognostic value of 3D whole heart volume (WHV) derived from non-contrast cardiac computed tomography (CT).
METHODS
Among participants randomized to the CT arm of the Prospective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE), we used deep learning to extract WHV, defined as the volume of the pericardial sac. We compared the WHV across categories of cardiovascular risk factors and coronary artery disease (CAD) characteristics and determined the association of WHV with MACE (all-cause death, myocardial infarction, unstable angina; median follow-up: 26 months).
RESULTS
In the 3798 included patients (60.5 ± 8.2 years; 51.5% women), the WHV was 351.9 ± 57.6 cm/m. We found smaller WHV in no- or non-obstructive CAD, women, people with diabetes, sedentary lifestyle, and metabolic syndrome. Larger WHV was found in obstructive CAD, men, and increased atherosclerosis cardiovascular disease (ASCVD) risk score (p < 0.05). In a time-to-event analysis, small WHV was associated with over 4.4-fold risk of MACE (HR (per one standard deviation) = 0.221; 95% CI: 0.068-0.721; p = 0.012) independent of ASCVD risk score and CT-derived CAD characteristics. In patients with non-obstructive CAD, but not in those with no- or obstructive CAD, WHV increased the discriminatory capacity of ASCVD and CT-derived CAD characteristics significantly.
CONCLUSIONS
Small WHV may represent a novel imaging marker of MACE in stable chest pain. In particular, WHV may improve risk stratification in patients with non-obstructive CAD, a cohort with an unmet need for better risk stratification.
KEY POINTS
• Heart volume is easily assessable from non-contrast cardiac computed tomography. • Small heart volume may be an imaging marker of major adverse cardiac events independent and incremental to traditional cardiovascular risk factors and established CT measures of CAD. • Heart volume may improve cardiovascular risk stratification in patients with non-obstructive CAD.
目的
心脏大小可能可以预测稳定型胸痛患者的主要心血管事件（MACE）。我们旨在评估非对比心脏计算机断层扫描（CT）得出的 3D 全心容积（WHV）的预后价值。
方法
在 Prospective Multicenter Imaging Study for Evaluation of Chest Pain（PROMISE）的 CT 臂随机分组的参与者中，我们使用深度学习技术提取 WHV，定义为心包囊的体积。我们比较了 WHV 在心血管危险因素和冠状动脉疾病（CAD）特征的类别之间的差异，并确定了 WHV 与 MACE（全因死亡、心肌梗死、不稳定型心绞痛；中位随访：26 个月）的关联。
结果
在纳入的 3798 例患者中（60.5 ± 8.2 岁；51.5%为女性），WHV 为 351.9 ± 57.6cm/m。我们发现无 CAD 或非阻塞性 CAD、女性、糖尿病患者、久坐不动的生活方式和代谢综合征患者的 WHV 较小。阻塞性 CAD、男性和 ASCVD 风险评分增加的患者 WHV 较大（p<0.05）。在生存时间分析中，WHV 较小与 MACE 的风险增加 4.4 倍以上相关（HR（每一个标准差）= 0.221；95%CI：0.068-0.721；p = 0.012），独立于 ASCVD 风险评分和 CT 得出的 CAD 特征。在非阻塞性 CAD 患者中，但在无 CAD 或阻塞性 CAD 患者中，WHV 显著提高了 ASCVD 和 CT 得出的 CAD 特征的区分能力。
结论
WHV 较小可能是稳定型胸痛患者发生 MACE 的新型影像学标志物。特别地，WHV 可能改善非阻塞性 CAD 患者的风险分层，这些患者需要更好的风险分层。
重点
心脏容积可通过非对比心脏 CT 轻松评估。
心脏容积小可能是主要不良心脏事件的影像学标志物，独立于传统心血管危险因素和已建立的 CT 评估 CAD 的指标。
心脏容积可能改善非阻塞性 CAD 患者的心血管风险分层。
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