心血管磁共振检查提示左心室充盈压升高的危险因素：预后分析
Risk factors for raised left ventricular filling pressure by cardiovascular magnetic resonance: Prognostic insights.
作者信息
Thomson Ross J, Grafton-Clarke Ciaran, Matthews Gareth, Swoboda Peter P, Swift Andrew J, Frangi Alejandro, Petersen Steffen E, Aung Nay, Garg Pankaj
机构信息
William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, UK.
Barts Heart Centre, St Bartholomew's Hospital, Barts NHS Trust, West Smithfield, London, UK.
出版信息
ESC Heart Fail. 2024 Dec;11(6):4148-4159. doi: 10.1002/ehf2.15011. Epub 2024 Aug 12.
BACKGROUND
Cardiovascular magnetic resonance (CMR) imaging shows promise in estimating pulmonary capillary wedge pressure (PCWP) non-invasively. At the population level, the prognostic role of CMR-modelled PCWP remains unknown. Furthermore, the relationship between CMR-modelled PCWP and established risk factors for cardiovascular disease has not been well characterized.
OBJECTIVE
The main aim of this study was to investigate the prognostic value of CMR-modelled PCWP at the population level.
METHODS
Employing data from the imaging substudy of the UK Biobank, a very large prospective population-based cohort study, CMR-modelled PCWP was calculated using a model incorporating left atrial volume, left ventricular mass and sex. Logistic regression explored the relationships between typical cardiovascular risk factors and raised CMR-modelled PCWP (≥15 mmHg). Cox regression was used to examine the impact of typical risk factors and CMR-modelled PCWP on heart failure (HF) and major adverse cardiovascular events (MACE).
RESULTS
Data from 39 163 participants were included in the study. Median age of all participants was 64 years (inter-quartile range: 58 to 70), and 47% were males. Clinical characteristics independently associated with raised CMR-modelled PCWP included hypertension [odds ratio (OR) 1.57, 95% confidence interval (CI) 1.44-1.70, P < 0.001], body mass index (BMI) [OR 1.57, 95% CI 1.52-1.62, per standard deviation (SD) increment, P < 0.001], male sex (OR 1.37, 95% CI 1.26-1.47, P < 0.001), age (OR 1.33, 95% CI 1.27-1.41, per decade increment, P < 0.001) and regular alcohol consumption (OR 1.10, 95% CI 1.02-1.19, P = 0.012). After adjusting for potential confounders, CMR-modelled PCWP was independently associated with incident HF [hazard ratio (HR) 2.91, 95% CI 2.07-4.07, P < 0.001] and MACE (HR 1.48, 95% CI 1.16-1.89, P = 0.002).
CONCLUSIONS
Raised CMR-modelled PCWP is an independent risk factor for incident HF and MACE. CMR-modelled PCWP should be incorporated into routine CMR reports to guide HF diagnosis and further management.
背景
心血管磁共振（CMR）成像在无创估计肺毛细血管楔压（PCWP）方面显示出前景。在人群层面，CMR建模的PCWP的预后作用尚不清楚。此外，CMR建模的PCWP与既定的心血管疾病危险因素之间的关系尚未得到充分描述。
目的
本研究的主要目的是在人群层面研究CMR建模的PCWP的预后价值。
方法
利用英国生物银行成像子研究的数据，这是一项基于人群的大型前瞻性队列研究，使用包含左心房容积、左心室质量和性别的模型计算CMR建模的PCWP。逻辑回归探讨了典型心血管危险因素与升高的CMR建模的PCWP（≥15 mmHg）之间的关系。Cox回归用于检验典型危险因素和CMR建模的PCWP对心力衰竭（HF）和主要不良心血管事件（MACE）的影响。
结果
39163名参与者的数据纳入了研究。所有参与者的中位年龄为64岁（四分位间距：58至70岁），47%为男性。与升高的CMR建模的PCWP独立相关的临床特征包括高血压[比值比（OR）1.57，95%置信区间（CI）1.44 - 1.70，P < 0.001]、体重指数（BMI）[OR 1.57，95% CI 1.52 - 1.62，每标准差（SD）增加，P < 0.001]、男性（OR 1.37，95% CI 1.26 - 1.47，P < 0.001）、年龄（OR 1.33，95% CI 1.27 - 1.41，每十年增加，P < 0.001）和经常饮酒（OR 1.10，95% CI 1.02 - 1.19，P = 0.012）。在调整潜在混杂因素后，CMR建模的PCWP与新发HF[风险比（HR）2.91，95% CI 2.07 - 4.07，P < 图001]和MACE（HR 1.48，95% CI 1.16 - 1.89，P = 0.002）独立相关。
结论
升高的CMR建模的PCWP是新发HF和MACE的独立危险因素。CMR建模的PCWP应纳入常规CMR报告，以指导HF诊断和进一步管理。
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