McCracken Celeste, Szabo Liliana, Abdulelah Zaid A, Condurache Dorina-Gabriela, Vago Hajnalka, Nichols Thomas E, Petersen Steffen E, Neubauer Stefan, Raisi-Estabragh Zahra
Division of Cardiovascular Medicine, Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, University of Oxford, National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK.
Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK.
Eur Heart J Open. 2024 Jul 25;4(4):oeae059. doi: 10.1093/ehjopen/oeae059. eCollection 2024 Jul.
Disruption of the predictable symmetry of the healthy heart may be an indicator of cardiovascular risk. This study defines the population distribution of ventricular asymmetry and its relationships across a range of prevalent and incident cardiorespiratory diseases.
The analysis includes 44 796 UK Biobank participants (average age 64.1 ± 7.7 years; 51.9% women). Cardiovascular magnetic resonance (CMR) metrics were derived using previously validated automated pipelines. Ventricular asymmetry was expressed as the ratio of left and right ventricular (LV and RV) end-diastolic volumes. Clinical outcomes were defined through linked health records. Incident events were those occurring for the first time after imaging, longitudinally tracked over an average follow-up time of 4.75 ± 1.52 years. The normal range for ventricular symmetry was defined in a healthy subset. Participants with values outside the 5th-95th percentiles of the healthy distribution were classed as either LV dominant (LV/RV > 112%) or RV dominant (LV/RV < 80%) asymmetry. Associations of LV and RV dominant asymmetry with vascular risk factors, CMR features, and prevalent and incident cardiovascular diseases (CVDs) were examined using regression models, adjusting for vascular risk factors, prevalent diseases, and conventional CMR measures. Left ventricular dominance was linked to an array of pre-existing vascular risk factors and CVDs, and a two-fold increased risk of incident heart failure, non-ischaemic cardiomyopathies, and left-sided valvular disorders. Right ventricular dominance was associated with an elevated risk of all-cause mortality.
Ventricular asymmetry has clinical utility for cardiovascular risk assessment, providing information that is incremental to traditional risk factors and conventional CMR metrics.
健康心脏可预测的对称性被破坏可能是心血管风险的一个指标。本研究定义了心室不对称的人群分布及其与一系列常见和新发心肺疾病的关系。
分析纳入了44796名英国生物银行参与者（平均年龄64.1±7.7岁；51.9%为女性）。心血管磁共振（CMR）指标通过先前验证的自动化流程得出。心室不对称表示为左心室和右心室（LV和RV）舒张末期容积的比值。临床结局通过关联的健康记录确定。新发事件是指成像后首次发生的事件，在平均4.75±1.52年的随访期内进行纵向跟踪。在健康亚组中定义了心室对称的正常范围。值超出健康分布第5至95百分位数的参与者被归类为左心室优势（LV/RV>112%）或右心室优势（LV/RV<80%）不对称。使用回归模型检验左心室和右心室优势不对称与血管危险因素、CMR特征以及常见和新发心血管疾病（CVD）的关联，并对血管危险因素、常见疾病和传统CMR测量进行校正。左心室优势与一系列已有的血管危险因素和CVD相关，且新发心力衰竭、非缺血性心肌病和左侧瓣膜疾病的风险增加两倍。右心室优势与全因死亡率升高相关。
心室不对称在心血管风险评估中具有临床实用性，提供了独立于传统危险因素和传统CMR指标的信息。
