区域应变评分作为动脉粥样硬化多民族研究（MESA）中心血管事件的预后标志物。
Regional Strain Score as Prognostic Marker of Cardiovascular Events From the Multi-Ethnic Study of Atherosclerosis (MESA).
作者信息
Pezel Theo, Bluemke David A, Wu Colin O, Lima João A C, Ambale Venkatesh Bharath
机构信息
Division of Cardiology, Johns Hopkins Hospital, School of Medicine, Johns Hopkins University, Baltimore, MD, United States.
Department of Cardiology, Lariboisiere Hospital - APHP, INSERM UMRS 942, University of Paris, Paris, France.
出版信息
Front Cardiovasc Med. 2022 May 13;9:870942. doi: 10.3389/fcvm.2022.870942. eCollection 2022.
BACKGROUND
Left ventricular (LV) circumferential strain (Ecc) is an accurate indicator of regional myocardial function, particularly using the regional Ecc or layer-specific strain.
AIM
This study aimed to investigate the prognostic value of a regional strain score (RSS) for predicting the incident of heart failure (HF) and coronary heart disease (CHD) in a population without a history of cardiovascular disease at baseline.
MATERIALS AND METHODS
Data from participants in the Multi-Ethnic Study of Atherosclerosis (MESA) who underwent tagged magnetic resonance imaging for strain determination were analyzed. Using -17% and -10% as Ecc cut-offs, each segment was rated from 0 to 2 points according to the Ecc value of each layer. The endo-Ecc, mid-Ecc, and epi-Ecc values from the 16-segment model were used to calculate three RSS: Endo-, Mid-, and Epi-RSS, respectively, which were defined as a percentage of good LV regional function. The Intramyocardial-RSS was the sum of these three RSS. Cox proportional hazard models were used to evaluate the association between each RSS and incident HF and hard CHD.
RESULTS
Among the 1,506 participants (63.3 ± 9.4 years, 54.6% men), 122 cases of hard CHD and 91 cases of HF were observed [median (IQR) follow-up 15.9 (12.9-16.6) years]. After adjustment, Mid-, Epi-, and Intramyocardial-RSS values <50% were independently associated with HF [adjusted HR 1.43; 95% CI (1.08-2.87), = 0.004; HR 1.80; 95% CI (1.12-3.07), < 0.001; and HR 2.01; 95% CI (1.19-3.20), < 0.001]. After adjustment, Endo-, Mid-, Epi-, and Intramyocardial-RSS <50% were also independently associated with hard CHD [adjusted HR 1.31; 95% CI (1.03-1.51), = 0.04; HR 1.79; 95% CI (1.26-2.57), < 0.001; HR 2.03; 95% CI (1.45-3.40), < 0.001; and HR 2.28; 95% CI (1.51-3.53), < 0.001].
CONCLUSIONS
Layer-specific regional Ecc, assessed by RSS, provides a robust, independent predictive value for incident HF and hard CHD in asymptomatic participants without any history of previous clinical cardiovascular disease.
CLINICAL TRIAL REGISTRATION
Unique identifier: NCT00005487.
背景
左心室（LV）圆周应变（Ecc）是区域心肌功能的准确指标，特别是使用区域Ecc或层特异性应变时。
目的
本研究旨在探讨区域应变评分（RSS）对预测基线时无心血管疾病史人群中心力衰竭（HF）和冠心病（CHD）发病的预后价值。
材料与方法
分析了动脉粥样硬化多民族研究（MESA）中接受标记磁共振成像以确定应变的参与者的数据。以-17%和-10%作为Ecc临界值，根据各层的Ecc值将每个节段从0到2分进行评分。使用16节段模型的内膜Ecc、中层Ecc和外膜Ecc值分别计算三个RSS：内膜、中层和外膜RSS，它们被定义为左心室良好区域功能的百分比。心肌内RSS是这三个RSS的总和。使用Cox比例风险模型评估每个RSS与HF和严重CHD发病之间的关联。
结果
在1506名参与者（63.3±9.4岁，54.6%为男性）中，观察到122例严重CHD和91例HF[中位（IQR）随访15.9（12.9-16.6）年]。调整后，中层、外膜和心肌内RSS值<50%与HF独立相关[调整后HR 1.43；95%CI（1.08-2.87），P = 0.004；HR 1.80；95%CI（1.12-3.07），P<0.001；以及HR 2.01；95%CI（1.19-3.20），P<0.001]。调整后，内膜、中层、外膜和心肌内RSS<50%也与严重CHD独立相关[调整后HR 1.31；95%CI（1.03-1.51），P = 0.04；HR 1.79；95%CI（1.26-2.57），P<0.001；HR 2.03；95%CI（1.45-3.40），P<0.001；以及HR 2.28；95%CI（1.51-3.53），P<0.001]。
结论
通过RSS评估的层特异性区域Ecc为无既往临床心血管疾病史的无症状参与者中HF和严重CHD的发病提供了强大的独立预测价值。
临床试验注册
唯一标识符：NCT00005487。
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