From the Division of Cardiology, Department of Medicine (A.A., Y.K., H.B., V.V., O.C., R.Z., M.R.O., J.A.C.L.), and Department of Radiology (B.A.V.), Johns Hopkins University, 600 N Wolfe St, Baltimore, MD 21287-0409; Office of Biostatistics Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (C.O.W.); Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (A.G.B.); Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill (S.J.S.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.).
Radiology. 2024 Jul;312(1):e232973. doi: 10.1148/radiol.232973.
Background Valvular heart disease and intracardiac shunts can disrupt the balance between left ventricular (LV) and right ventricular (RV) stroke volumes. However, the prognostic value of such imbalances has not been established among asymptomatic individuals. Purpose To assess the association between differential ventricular stroke volumes quantified using cardiac MRI and clinical outcomes in individuals without cardiovascular disease. Materials and Methods This secondary analysis of a prospective study included participants without cardiovascular disease at enrollment (July 2000 to July 2002) who underwent cardiac MRI. Differences in stroke volume were calculated as LV stroke volume minus RV stroke volume, and participants were categorized as having balanced (greater than or equal to -30 mL to ≤30 mL), negative (less than -30 mL), or positive (>30 mL) differential stroke volumes. Multivariable Cox proportional hazard regression models were used to test the association between differences in stroke volume and adverse outcomes. Results A cohort of 4058 participants (mean age, 61.4 years ± 10 [SD]; 2120 female) were included and followed up for a median of 18.4 years (IQR, 18.3-18.5 years). During follow-up, 1006 participants died, 235 participants developed heart failure, and 764 participants developed atrial fibrillation. Compared with participants who had a balanced differential stroke volume, those with an increased differential stroke volume showed a higher risk of mortality (hazard ratio [HR], 1.73 [95% CI: 1.12, 2.67]; = .01), heart failure (HR, 2.40 [95% CI: 1.11, 5.20]; = .03), and atrial fibrillation (HR, 1.89 [95% CI: 1.16, 3.08]; = .01) in adjusted models. Participants in the negative group, with a decreased differential stroke volume, showed an increased risk of heart failure compared with those in the balanced group (HR, 2.09 [95% CI: 1.09, 3.99]; = .03); however, this was no longer observed after adjusting for baseline LV function ( = .34). Conclusion Participants without cardiovascular disease at the time of study enrollment who had an LV stroke volume exceeding the RV stroke volume by greater than 30 mL had an increased risk of mortality, heart failure, and atrial fibrillation compared with those with balanced stroke volumes. ClinicalTrials.gov Identifier: NCT00005487 © RSNA, 2024 See also the editorial by Almeida in this issue.
背景
瓣膜性心脏病和心内分流会破坏左心室（LV）和右心室（RV）的每搏输出量之间的平衡。然而，在无症状个体中，这种失衡的预后价值尚未确定。
目的
评估使用心脏 MRI 量化的差异心室每搏输出量与无心血管疾病个体临床结局之间的关联。
材料与方法
本研究为前瞻性研究的二次分析，纳入了 2000 年 7 月至 2002 年 7 月入组时无心血管疾病的参与者，并进行了心脏 MRI 检查。每搏输出量的差异是通过 LV 每搏输出量减去 RV 每搏输出量计算的，参与者分为平衡组（差值大于或等于-30 毫升至小于或等于 30 毫升）、负差值组（小于-30 毫升）或正差值组（大于 30 毫升）。使用多变量 Cox 比例风险回归模型检验每搏输出量差异与不良结局之间的关联。
结果
共纳入 4058 名参与者（平均年龄 61.4 岁±10[SD]；2120 名女性），中位随访时间为 18.4 年（IQR，18.3-18.5 年）。随访期间，1006 名参与者死亡，235 名参与者发生心力衰竭，764 名参与者发生心房颤动。与平衡差每搏输出量的参与者相比，每搏输出量增加的参与者的死亡率风险更高（危险比[HR]，1.73[95%CI：1.12，2.67]； =.01）、心力衰竭（HR，2.40[95%CI：1.11，5.20]； =.03）和心房颤动（HR，1.89[95%CI：1.16，3.08]； =.01）在调整后的模型中。负差值组（每搏输出量减少）的参与者发生心力衰竭的风险高于平衡组（HR，2.09[95%CI：1.09，3.99]； =.03）；然而，在调整基线 LV 功能后，这种关联不再存在（ =.34）。
结论
与平衡的每搏输出量相比，在研究入组时无心血管疾病的参与者，如果 LV 每搏输出量超过 RV 每搏输出量 30 毫升以上，则与死亡率、心力衰竭和心房颤动的风险增加相关。
ClinicalTrials.gov 标识符：NCT00005487
© RSNA，2024
另见本期 Almeida 的社论。
Zotero 插件