Heart and Vascular Center, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
Cardiovascular Imaging Program, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
Eur Heart J. 2022 Sep 14;43(35):3323-3331. doi: 10.1093/eurheartj/ehab610.
The transition from hypertension to heart failure (HF) remains poorly understood. We hypothesized that insufficient perfusion to match global metabolic demand, reflected by a low ratio of myocardial blood flow to global myocardial mass, may be a HF risk marker.
A retrospective cohort (n = 346) of patients with hypertension who underwent clinical positron emission tomography (PET) myocardial perfusion imaging for chest pain and/or dyspnoea at Brigham and Women's Hospital (Boston, MA, USA) were studied. Patients without obstructive coronary artery disease by history or PET perfusion (summed stress score <3), HF, cardiomyopathy, or ejection fraction (EF) <40% were followed for HF hospitalization (primary outcome), all-cause death, and their composite. Myocardial blood flow, left ventricular (LV) mass, volumes, and EF were obtained from PET, and a 'flow/mass ratio' was determined as hyperaemic myocardial blood flow over LV mass indexed to body surface area. A lower flow/mass ratio was independently associated with larger end-diastolic (β = -0.44, P < 0.001) and end-systolic volume (β = -0.48, P < 0.001) and lower EF (β = 0.33, P < 0.001). A flow/mass ratio below the median was associated with an adjusted hazard ratio of 2.47 [95% confidence interval (CI) 1.24-4.93; P = 0.01] for HF hospitalization, 1.95 (95% CI 1.12-3.41; P = 0.02) for death, and 2.20 (95% CI 1.39-3.49; P < 0.001) for the composite.
An integrated physiological measure of insufficient myocardial perfusion to match global metabolic demand identifies subclinical hypertensive heart disease and elevated risk of HF and death in symptomatic patients with hypertension but without flow-limiting coronary artery disease.
从高血压到心力衰竭（HF）的转变仍知之甚少。我们假设，全球代谢需求的心肌血流与整体心肌质量的低比值（反映灌注不足），可能是 HF 的风险标志物。
回顾性队列研究（n=346）纳入了因胸痛和/或呼吸困难在布莱根妇女医院（波士顿，MA，美国）接受临床正电子发射断层扫描（PET）心肌灌注成像检查的高血压患者。根据病史或 PET 灌注（总和应激评分<3）、HF、心肌病或射血分数（EF）<40%排除有阻塞性冠状动脉疾病、HF、心肌病或 EF<40%的患者，随访 HF 住院（主要结局）、全因死亡和复合终点。从 PET 中获得心肌血流、左心室（LV）质量、容量和 EF，并确定“血流/质量比”作为高血流量与 LV 质量除以体表面积的比值。较低的血流/质量比与较大的舒张末期（β=-0.44，P<0.001）和收缩末期容积（β=-0.48，P<0.001）和较低的 EF（β=0.33，P<0.001）独立相关。低于中位数的血流/质量比与 HF 住院的校正风险比为 2.47（95%置信区间（CI）1.24-4.93；P=0.01）、死亡的校正风险比为 1.95（95% CI 1.12-3.41；P=0.02）和复合终点的校正风险比为 2.20（95% CI 1.39-3.49；P<0.001）。
一种综合的心肌灌注不足以满足全球代谢需求的生理测量指标，可识别有症状的高血压患者中无症状性高血压性心脏病和 HF 及死亡的风险升高，但无限制血流的冠状动脉疾病。
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