Zhou Zeming, Wang Wei, Tian Lili, Peng Yue, Lei Lubi, Li Jingkuo, Pu Boxuan, Zhang Lihua, Zheng Xin
National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China.
Center for Clinical and Epidemiologic Research, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.
Heliyon. 2024 Aug 27;10(17):e37026. doi: 10.1016/j.heliyon.2024.e37026. eCollection 2024 Sep 15.
An association between increased aortic root dimensions (ARD) and elevated risk of cardiovascular mortality has been reported in the general population. However, evidence regarding the association between ARD and mortality in patients with acute heart failure (AHF) is limited.
In a nationwide prospective cohort of the China Patient-Centered Evaluative Assessment of Cardiac Events Prospective Heart Failure Study, ARD was measured during diastole using echocardiography and indexed to body mass index (BMI). Cox proportional hazard models were used to validate the association between BMI-indexed ARD and mortality. Additionally, the relationship between BMI-indexed ARD and mortality was presented using restricted cubic spline in all populations, and both sexes.
A total of 2125 participants with ARD were included in the final analysis, among of 38.4 % were women, with a median age of 67 years. Over a median follow-up period of 54.4 (interquartile range: 30.1 to 59.7) months, 895 deaths occurred, with 750 attributed to cardiovascular causes and 145 to non-cardiovascular causes. Compared to the highest tertile group of BMI-indexed ARD, the lowest tertile group had a lower risk of cardiovascular mortality (hazard ratio [HR], 0.71; 95 % confidence interval [CI], 0.58 to 0.87; < 0.001) and all-cause mortality (HR, 0.68; 95 % CI, 0.56 to 0.81; < 0.001). Similarly, the middle tertile group also had a lower risk of cardiovascular mortality (HR, 0.78; 95 % CI, 0.65 to 0.93; = 0.007) and all-cause mortality (HR, 0.75; 95 % CI, 0.63 to 0.89; < 0.001). Considering the competing risks, the lowest BMI-indexed ARD groups showed a significant mortality risk of cardiovascular mortality in all populations, and both sexes. Moreover, the relationship between BMI-indexed ARD and mortality was linear in males, while a "J" shaped relationship was observed in females.
Lower BMI-indexed ARD was associated with a decreased risk of all-cause and cardiovascular mortality than those with higher BMI-indexed ARD in AHF. Additionally, a discrepancy was observed between the sexes in the relationship between BMI-indexed ARD and mortality. These findings contribute to the prompt identification of potential mortality risks in patients with AHF.
在普通人群中，已报道主动脉根部尺寸增加（ARD）与心血管疾病死亡风险升高之间存在关联。然而，关于急性心力衰竭（AHF）患者中ARD与死亡率之间关联的证据有限。
在中国心脏事件前瞻性心力衰竭研究这一全国性前瞻性队列研究中，采用超声心动图在舒张期测量ARD，并将其与体重指数（BMI）进行指数化。使用Cox比例风险模型验证BMI指数化ARD与死亡率之间的关联。此外，在所有人群以及男性和女性中，使用受限立方样条展示BMI指数化ARD与死亡率之间的关系。
共有2125名有ARD的参与者纳入最终分析，其中38.4%为女性，中位年龄为67岁。在中位随访期54.4（四分位间距：30.1至59.7）个月期间，发生了895例死亡，其中750例归因于心血管原因，145例归因于非心血管原因。与BMI指数化ARD最高三分位数组相比，最低三分位数组的心血管疾病死亡风险较低（风险比[HR]，0.71；95%置信区间[CI]，0.58至0.87；P<0.001），全因死亡风险也较低（HR，0.68；95%CI，0.56至0.81；P<0.001）。同样，中间三分位数组的心血管疾病死亡风险也较低（HR，0.78；95%CI，0.65至0.93；P = 0.007），全因死亡风险也较低（HR，0.75；95%CI，0.63至0.89；P<0.001）。考虑到竞争风险，最低BMI指数化ARD组在所有人群以及男性和女性中均显示出显著的心血管疾病死亡风险。此外，BMI指数化ARD与死亡率之间的关系在男性中呈线性，而在女性中观察到“J”形关系。
与BMI指数化ARD较高的患者相比，较低的BMI指数化ARD与AHF患者的全因和心血管疾病死亡风险降低相关。此外，在BMI指数化ARD与死亡率之间的关系上观察到了性别差异。这些发现有助于及时识别AHF患者潜在的死亡风险。
