左心房延迟钆增强与心房颤动之间的关联：动脉粥样硬化多民族研究（MESA）
Association between Left Atrial Late Gadolinium Enhancement and Atrial Fibrillation: The Multi-Ethnic Study of Atherosclerosis (MESA).
作者信息
Zghaib Tarek, Quinaglia A C Silva Thiago, Ambale-Venkatesh Bharath, Xie Eric, Ostovaneh Mohammad R, Habibi Mohammadali, Bluemke David A, Soliman Elsayed Z, Wu Colin O, Heckbert Susan R, Nazarian Saman, Lima João A C
机构信息
From the Departments of Medicine (T.Z., E.X.) and Cardiology (T.Z., T.Q.A.C.S., M.R.O., M.H., J.A.C.L.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287; Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, Md (B.A.V.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.); Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, NC (E.Z.S.); National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Md (C.O.W.); Department of Epidemiology, University of Washington, Seattle, Wash (S.R.H.); and Division of Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (S.N.).
出版信息
Radiol Cardiothorac Imaging. 2023 Jul 13;5(4):e220047. doi: 10.1148/ryct.220047. eCollection 2023 Aug.
PURPOSE
To determine the prevalence and correlates of left atrial (LA) late gadolinium enhancement (LGE) at cardiac MRI and its association with atrial fibrillation (AF) in a population-based sample from the Multi-Ethnic Study of Atherosclerosis (MESA).
MATERIALS AND METHODS
In this secondary post hoc analysis of the MESA cohort (ClinicalTrials.gov no. NCT00005487), participants without AF underwent LGE cardiac MRI at the fifth examination (2010-2012). LA LGE burden was quantified using the image intensity ratio technique on biplane long-axis two-dimensional (2D) LGE images without fat saturation. Survival analysis was performed with log-rank testing and Cox regression.
RESULTS
Of 1697 participants (mean age, 67 years ± 9 [SD]; 872 men), 1035 (61%) had LA LGE, and 75 (4.4%) developed AF during follow-up (median, 3.95 years). At univariable analysis, LA LGE was associated with age (β = .010 [95% CI: .005, .015], < .001), diastolic blood pressure (β = .005 [95% CI: .001, .009], = .02), HbA1c level (β = .06 [95% CI: .02, .11], = .009), heart failure (β = .60 [95% CI: .11, 1.08], = .02), LA volume (β = .008 [95% CI: .004, .012], < .001), and LA function (emptying fraction, LA global longitudinal strain, LA early diastolic peak longitudinal strain rate, and LA late diastolic peak strain rate; all < .05). After adjusting for the variables in the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) AF score, LA LGE independently helped predict incident AF (hazard ratio = 1.46 [95% CI: 1.13, 1.88], = .003). The highest tertile (LGE > 2%) was twice as likely to develop AF.
CONCLUSION
Although limited by the 2D LGE technique employed, LA LGE was associated with adverse atrial remodeling and helped predict AF in a multiethnic population-based sample.Clinical trial registration no. NCT00005487 MR Imaging, Cardiac, Epidemiology © RSNA, 2023.
目的
在动脉粥样硬化多族裔研究（MESA）的基于人群样本中，确定心脏磁共振成像（MRI）时左心房（LA）延迟钆增强（LGE）的患病率及其相关因素，以及它与心房颤动（AF）的关联。
材料与方法
在对MESA队列进行的这项二次事后分析（ClinicalTrials.gov编号：NCT00005487）中，无AF的参与者在第五次检查（2010 - 2012年）时接受了LGE心脏MRI检查。使用图像强度比技术在无脂肪饱和的双平面长轴二维（2D）LGE图像上对LA LGE负荷进行量化。采用对数秩检验和Cox回归进行生存分析。
结果
1697名参与者（平均年龄67岁±9[标准差]；872名男性）中，1035名（61%）有LA LGE，75名（4.4%）在随访期间（中位时间3.95年）发生了AF。单变量分析时，LA LGE与年龄（β = 0.010[95%置信区间：0.005，0.015]，P < 0.001）、舒张压（β = 0.005[95%置信区间：0.001，0.009]，P = 0.02）、糖化血红蛋白水平（β = 0.06[95%置信区间：0.02，0.11]，P = 0.009）、心力衰竭（β = 0.60[95%置信区间：0.11，1.08]，P = 0.02）、LA容积（β = 0.008[95%置信区间：0.004，0.012]，P < 0.001）以及LA功能（排空分数、LA整体纵向应变、LA舒张早期纵向峰值应变率和LA舒张晚期峰值应变率；均P < 0.05）相关。在根据基因组流行病学心脏与衰老研究队列（CHARGE）AF评分对变量进行调整后，LA LGE独立有助于预测新发AF（风险比 = 1.46[95%置信区间：1.13，1.88]，P = 0.003）。最高三分位数（LGE > 2%）发生AF 的可能性是两倍。
结论
尽管受所采用的2D LGE技术限制，LA LGE与不良心房重构相关，并有助于在基于多族裔人群的样本中预测AF。临床试验注册号：NCT00005487 MR成像，心脏，流行病学 ©RSNA，2023
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