Department of Cardiology, Smidt Heart Institute and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Framingham Heart Study, Framingham, Massachusetts, USA.
Heart. 2022 Oct 28;108(22):1800-1806. doi: 10.1136/heartjnl-2022-320876.
Established preclinical imaging assessments of heart failure (HF) risk are based on macrostructural cardiac remodelling. Given that microstructural alterations may also influence HF risk, particularly in women, we examined associations between microstructural alterations and incident HF.
We studied N=2511 adult participants (mean age 65.7±8.8 years, 56% women) of the Framingham Offspring Study who were free of cardiovascular disease at baseline. We employed texture analysis of echocardiography to quantify microstructural alteration, based on the high spectrum signal intensity coefficient (HS-SIC). We examined its relations to incident HF in sex-pooled and sex-specific Cox models accounting for traditional HF risk factors and macrostructural alterations.
We observed 94 new HF events over 7.4±1.7 years. Individuals with higher HS-SIC had increased risk for incident HF (HR 1.67 per 1-SD in HS-SIC, 95% CI 1.31 to 2.13; p<0.0001). Adjusting for age and antihypertensive medication use, this association was significant in women (p=0.02) but not men (p=0.78). Adjusting for traditional risk factors (including body mass index, total/high-density lipoprotein cholesterol, blood pressure traits, diabetes and smoking) attenuated the association in women (HR 1.30, p=0.07), with mediation of HF risk by the HS-SIC seen for a majority of these risk factors. However, the HS-SIC association with HF in women remained significant after adjusting for relative wall thickness (representing macrostructure alteration) in addition to these risk factors (HR 1.47, p=0.02).
Cardiac microstructural alterations are associated with elevated risk for HF, particularly in women. Microstructural alteration may identify sex-specific pathways by which individuals progress from risk factors to clinical HF.
已建立的心力衰竭（HF）风险的临床前影像学评估基于宏观结构的心脏重塑。鉴于微观结构改变也可能影响 HF 风险，特别是在女性中，我们研究了微观结构改变与 HF 事件的相关性。
我们研究了弗雷明汉后代研究中的 2511 名成年参与者（平均年龄 65.7±8.8 岁，56%为女性），他们在基线时没有心血管疾病。我们采用超声心动图的纹理分析来量化微观结构改变，基于高光谱信号强度系数（HS-SIC）。我们在性别混合和性别特异性 Cox 模型中检查了其与 HF 事件的关系，这些模型考虑了传统的 HF 风险因素和宏观结构改变。
我们观察到 7.4±1.7 年内发生了 94 例新的 HF 事件。HS-SIC 较高的个体发生 HF 事件的风险增加（HR 每 1-SD 增加 1.67，95%CI 为 1.31 至 2.13；p<0.0001）。调整年龄和抗高血压药物使用后，这种相关性在女性中具有统计学意义（p=0.02），但在男性中无统计学意义（p=0.78）。调整传统危险因素（包括体重指数、总/高密度脂蛋白胆固醇、血压特征、糖尿病和吸烟）后，这种相关性在女性中减弱（HR 为 1.30，p=0.07），HS-SIC 通过大多数这些危险因素对 HF 风险的中介作用可见。然而，在调整了这些危险因素以及相对壁厚度（代表宏观结构改变）后，女性中 HS-SIC 与 HF 的相关性仍然显著（HR 为 1.47，p=0.02）。
心脏微观结构改变与 HF 风险增加相关，特别是在女性中。微观结构改变可能确定了个体从危险因素发展为临床 HF 的特定性别途径。
