White Audrey, Dixon Debra D, Agrawal Vineet, Brittain Evan, Lindman Brian, Mallugari Ravinder, Mosley Jonathan D, Perry Andrew S, Shah Ravi V, Wells Quinn S, Kuipers Allison L, Gupta Deepak K
Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
JACC Adv. 2024 Sep 13;3(10):101262. doi: 10.1016/j.jacadv.2024.101262. eCollection 2024 Oct.
Greater left ventricular (LV) wall stress is associated with adverse outcomes among patients with prevalent heart failure (HF). Less is known about the association between LV wall stress and incident HF.
The purpose of the study was to identify clinical factors associated with wall stress and test the association between wall stress and incident HF.
We studied 4,601 ARIC (Atherosclerosis Risk In Communities) study participants without prevalent HF who underwent echocardiography between 2011 and 2013. LV end systolic and diastolic wall stress (LVESWS, LVEDWS) were calculated from chamber and wall thickness, systemic blood pressure, and transmitral Doppler E/e' as a surrogate for LV end diastolic pressure. Incident HF was ascertained by International Classification of Diseases (ICD)-9/10 claims for hospitalized HF through December 31, 2016. We used Cox regression to test the association between wall stress and incident HF, adjusted for demographics, traditional cardiovascular risk factors, prevalent coronary artery disease and atrial fibrillation, creatinine, N-terminal pro-B-type natriuretic peptide, troponin, triglycerides, C-reactive protein, LV ejection fraction, and LV mass.
The cohort had a median age of 75 years and 58% women, with 18% identifying as Black. Median LVESWS and LVEDWS were 48.8 (25th-75th percentile: 39.3-60.1) and 18.9 (25th-75th percentile: 15.8-22.5) kdynes/cm, respectively. LVESWS and LVEDWS were modestly related (rho = 0.30, < 0.001). Over 4.6 years of median follow-up (156 HF events), each 1 kdyne/cm greater LVEDWS was significantly associated with higher risk of incident HF (HR: 1.03; 95% CI: 1.01-1.06), while LVESWS was not (HR: 1.00; 95% CI: 0.99-1.01).
Among community-dwelling elderly individuals, greater LVEDWS is associated with a higher risk for incident HF.
在患有心力衰竭（HF）的患者中，左心室（LV）壁应力增加与不良预后相关。关于LV壁应力与新发HF之间的关联，人们了解较少。
本研究旨在确定与壁应力相关的临床因素，并检验壁应力与新发HF之间的关联。
我们研究了4601名社区动脉粥样硬化风险（ARIC）研究参与者，他们在2011年至2013年期间接受了超声心动图检查，且当时没有HF。LV收缩末期和舒张末期壁应力（LVESWS、LVEDWS）通过腔室和壁厚度、体循环血压以及二尖瓣多普勒E/e'计算得出，E/e'作为LV舒张末期压力的替代指标。通过国际疾病分类（ICD）-9/10中关于住院HF的记录确定新发HF，随访至2016年12月31日。我们使用Cox回归检验壁应力与新发HF之间的关联，并对人口统计学、传统心血管危险因素、既往冠心病和心房颤动、肌酐、N末端B型利钠肽原、肌钙蛋白、甘油三酯、C反应蛋白、LV射血分数和LV质量进行了调整。
该队列的中位年龄为75岁，女性占58%，其中18%为黑人。LVESWS和LVEDWS的中位数分别为48.8（第25-75百分位数：39.3-60.1）和18.9（第25-75百分位数：15.8-22.5）kdynes/cm。LVESWS和LVEDWS呈中等程度相关（rho = 0.30，P < 0.001）。在中位随访4.6年期间（156例HF事件），LVEDWS每增加1 kdyne/cm与新发HF风险显著升高相关（HR：1.03；95%CI：1.01-1.06），而LVESWS则不然（HR：1.00；95%CI：0.99-1.01）。
在社区居住的老年人中，较高的LVEDWS与新发HF的较高风险相关。
