心血管纤维化、重构和功能障碍与虚弱、衰弱前期和功能表现的关联：动脉粥样硬化的多民族研究。
Association of Cardiovascular Fibrosis, Remodeling, and Dysfunction With Frailty, Prefrailty, and Functional Performance: The Multi-Ethnic Study of Atherosclerosis.
机构信息
Department of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Center on Aging and Health, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
出版信息
J Gerontol A Biol Sci Med Sci. 2024 Aug 1;79(8). doi: 10.1093/gerona/glae142.
BACKGROUND
Cardiovascular disease is associated with higher incidence of frailty. However, the nature of the mechanisms underlying this association remains unclear. The purpose of this study is to identify cardiovascular phenotypes most associated with physical frailty and functional performance in the Multi-Ethnic Study of Atherosclerosis (MESA).
METHODS
As part of the MESA study, 3 045 participants underwent cardiovascular magnetic resonance and computed tomography between 2010 and 2012. Of these, 1 743 completed a Six-Minute Walk test (6MWT) and questionnaires (follow-up exam: 2016-2018) which were used to generate a binary combined frail/prefrail versus robust score according to a modified FRAIL Scale (self-report questionnaire). Multivariable logistic (binary frail outcome) or linear (6MWT) regression assessed the association between frailty and cardiovascular structure and function, aortic stiffness, coronary artery calcium, and myocardial fibrosis (ECV, extracellular volume fraction).
RESULTS
Participants were 66 ± 8 years, 52% female at the time of imaging, and 29.4% were classified as frail or prefrail. Older age and female gender were associated with greater odds of being in the frail/prefrail group. Concentric left ventricular remodeling (odds ratio [OR] 1.89, p = .008; Coef. -52.9, p < .001), increased ECV (OR 1.10, p = .002; Coef. -4.0, p = .001), and worsening left atrial strain rate at early diastole (OR 1.56, p ≤ .001; Coef. -22.75, p = .027) were found to be associated with a greater likelihood of being in a frail state and lower 6MWT distance (m). All associations with 6MWT performance were attenuated with adjustments for risk factors whereas ECV and LA strain rate remained independently associated with frailty.
CONCLUSIONS
These findings suggest a significant overlap in pathways associated with subclinical cardiac dysfunction, cardiovascular fibrosis, and physical frailty.
背景
心血管疾病与虚弱的发病率较高有关。然而，这种关联的机制本质尚不清楚。本研究的目的是确定与多民族动脉粥样硬化研究（MESA）中身体虚弱和功能表现最相关的心血管表型。
方法
作为 MESA 研究的一部分，3045 名参与者在 2010 年至 2012 年期间接受了心血管磁共振和计算机断层扫描。其中，1743 名参与者完成了 6 分钟步行测试（6MWT）和问卷调查（随访检查：2016-2018 年），根据改良的 FRAIL 量表（自我报告问卷）生成了虚弱/衰弱前与强壮的二分组合计分数。多变量逻辑（虚弱的二分结果）或线性（6MWT）回归评估了虚弱与心血管结构和功能、主动脉僵硬、冠状动脉钙和心肌纤维化（ECV，细胞外体积分数）之间的关系。
结果
参与者在成像时的年龄为 66±8 岁，52%为女性，29.4%被归类为虚弱或衰弱前。年龄较大和女性性别与更有可能处于虚弱/衰弱前组相关。左心室向心性重构（比值比 [OR] 1.89，p=0.008；系数-52.9，p<0.001）、ECV 增加（OR 1.10，p=0.002；系数-4.0，p=0.001）和舒张早期左心房应变率恶化（OR 1.56，p≤0.001；系数-22.75，p=0.027）与虚弱状态的可能性增加和 6MWT 距离（m）降低相关。所有与 6MWT 表现的关联在调整危险因素后均减弱，而 ECV 和左心房应变率仍与虚弱独立相关。
结论
这些发现表明，与亚临床心功能障碍、心血管纤维化和身体虚弱相关的途径存在显著重叠。
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