冠心病 CT 血管造影对射血分数保留型心力衰竭患者的预后价值。
Prognostic value of coronary CT angiography in heart failure patients with preserved ejection fraction.
机构信息
Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, No.180 Fenglin Road, Xuhui District, Shanghai, 200032, China.
Department of Echocardiography, Zhongshan Hospital, Fudan University, No.180 Fenglin Road, Xuhui District, Shanghai, 200032, China.
出版信息
Eur Radiol. 2023 May;33(5):3052-3063. doi: 10.1007/s00330-022-09380-4. Epub 2023 Jan 11.
OBJECTIVES
To investigate the prognostic value of coronary CT angiography (CCTA) in heart failure patients with preserved ejection fraction (HFpEF).
METHODS
Between January 2009 and December 2013, 6497 participants (mean age 63 ± 9.4 [range 32-86] years; 4111 men) who underwent CCTA and echocardiography were prospectively included. Participants were divided into HFpEF group and without HFpEF group. The primary endpoint was major adverse cardiovascular events (MACEs), including cardiovascular mortality, nonfatal myocardial infarction (MI), or hospitalization for heart failure (HF).
RESULTS
Among those participants, 3096 were identified with HFpEF and 3401 were without HFpEF. Higher prevalence of coronary atherosclerosis was observed in HFpEF group than those without (78.3% vs. 64.9%, p < 0.001). During a median of 11.0 [IQR: 9.0-12.0] years follow-up, participants with HFpEF exhibit a heightened risk of MACEs in CAD-RADS = 0, 1-2, and ≥ 3 respectively (p < 0.001 for all). In the risk-adjusted hazard analysis among participants with HFpEF, CAD-RADS = 1-2 increased a 2.5-time risk for non-fatal MI (adjusted HR: 2.5, 95% CI: 1.5 to 4.3, p < 0.001), while CAD-RADS ≥ 3 conferred 3.9-fold and 3.1-fold higher risk for cardiovascular mortality (adjusted HR: 3.9, 95% CI: 2.2 to 7.1, p < 0.001) and hospitalization due to HF (adjusted HR: 3.1, 95% CI: 1.9 to 5.3, p < 0.001) with reference to CAD-RADS = 0 respectively.
CONCLUSIONS
Coronary artery disease is common in participants with HFpEF and associated with MACEs. Among those participants, the presence of CAD-RADS = 1-2 increased the risk of nonfatal MI, while CAD-RADS ≥ 3 were correlated with cardiovascular mortality and hospitalization due to HF.
KEY POINTS
• Higher median of CACS and higher CAD-RADS categories were observed in the HFpEF group than those without (p < 0.001 for both). • Participants with HFpEF exhibit a heightened risk of MACEs in CAD-RADS = 0, 1-2, and ≥ 3 respectively (p < 0.001 for all). • In the risk-adjusted hazard analysis among participants with HFpEF, CAD-RADS =1-2 increased a 2.5-time risk for non-fatal MI (adjusted HR: 2.5, 95% CI: 1.5 to 4.3, p < 0.001) with reference to CAD-RADS = 0 respectively.
目的
探讨冠状动脉 CT 血管造影（CCTA）在射血分数保留的心力衰竭（HFpEF）患者中的预后价值。
方法
2009 年 1 月至 2013 年 12 月，前瞻性纳入 6497 名接受 CCTA 和超声心动图检查的参与者（平均年龄 63±9.4[范围 32-86]岁；4111 名男性）。参与者被分为 HFpEF 组和非 HFpEF 组。主要终点为主要不良心血管事件（MACEs），包括心血管死亡率、非致死性心肌梗死（MI）或心力衰竭（HF）住院。
结果
在这些参与者中，有 3096 人被确定为 HFpEF，有 3401 人没有 HFpEF。HFpEF 组的冠状动脉粥样硬化发生率高于非 HFpEF 组（78.3%比 64.9%，p<0.001）。在中位随访 11.0[IQR：9.0-12.0]年后，HFpEF 患者在 CAD-RADS=0、1-2 和≥3 时发生 MACE 的风险增加（p<0.001）。在 HFpEF 患者的风险调整后危险比分析中，CAD-RADS=1-2 增加了非致死性 MI 的 2.5 倍风险（调整后的 HR：2.5，95%CI：1.5 至 4.3，p<0.001），而 CAD-RADS≥3 分别增加了心血管死亡率（调整后的 HR：3.9，95%CI：2.2 至 7.1，p<0.001）和 HF 住院的 3.1 倍风险（调整后的 HR：3.1，95%CI：1.9 至 5.3，p<0.001）。
结论
HFpEF 患者中常见冠状动脉疾病，与 MACEs 相关。在这些患者中，CAD-RADS=1-2 增加了非致死性 MI 的风险，而 CAD-RADS≥3 与心血管死亡率和 HF 住院有关。
重点
•HFpEF 组的中位 CACS 较高，CAD-RADS 分类较高（均 p<0.001）。•HFpEF 患者在 CAD-RADS=0、1-2 和≥3 时发生 MACE 的风险分别增加（均 p<0.001）。•在 HFpEF 患者的风险调整后危险比分析中，CAD-RADS=1-2 与 CAD-RADS=0 相比，非致死性 MI 的风险增加了 2.5 倍（调整后的 HR：2.5，95%CI：1.5 至 4.3，p<0.001）。
Zotero 插件