累积血压暴露与全球及区域心脏结构和功能：多族裔动脉粥样硬化研究（MESA）

Cumulative Blood Pressure Exposure and Global and Regional Cardiac Structure and Function: The MESA Study.

作者信息

Masrouri Soroush, Tabnak Peyman, Chevli Parag, Mirzai Saeid, Slipczuk Leandro, Vasu Sujethra, Lima Joao A C, Shapiro Michael D

机构信息

Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.

出版信息

Eur J Prev Cardiol. 2025 Mar 19. doi: 10.1093/eurjpc/zwaf163.

DOI:10.1093/eurjpc/zwaf163

PMID:40106653

Abstract

AIMS

This study examined the associations between decade-long cumulative blood pressure (BP) exposure and global/regional myocardial structure and function independent of current BP levels.

METHODS

We analyzed 3,015 adults (aged 69.0±9.2 years) from the Multi-Ethnic Study of Atherosclerosis (MESA) who underwent cardiac magnetic resonance (CMR) imaging at year 10 (exam 5, 2010-2012). Measures included left ventricular (LV) parameters, global/regional myocardial function via tagged CMR, interstitial myocardial fibrosis (IMF) via T1-mapping measures (native T1 and extracellular volume fraction [ECV]), and myocardial scar via late gadolinium enhancement (LGE). We used cumulative exposure of BP through baseline and up to exam 5 (millimeters of mercury × year) to represent long-term exposure to BP levels. Linear regression, logistic regression, and generalized additive models were used to quantify the association of cumulative BP parameters with measures of cardiac structure and function.

RESULTS

Higher cumulative systolic BP (SBP), independent of current SBP, correlated with increased LV mass index (1.93 g/m² per SD), worse global/regional circumferential strain (0.24% to 0.38% lower absolute values per SD), and greater myocardial scar risk (OR: 1.36, 95% CI: 1.02-1.82 per SD). Cumulative diastolic BP (DBP) was associated with circumferential strain, showing nearly J-shaped relationships after adjusting for current DBP (all P < 0.05). In non-hypertensive individuals with BP consistently below the hypertension threshold, cumulative SBP remained significantly associated with LV mass index and strain but not myocardial scar (OR: 1.53, 95% CI: 0.82-2.87, P=0.19).

CONCLUSION

Higher cumulative BP was associated with worse global and regional cardiac structure/function and myocardial scar, independent of a single BP at the time of imaging, and was still observed to some extent in non-hypertensive individuals who consistently maintained blood pressure levels below the hypertension threshold.

摘要

目的

本研究探讨了长达十年的累积血压（BP）暴露与整体/局部心肌结构和功能之间的关联，且不受当前血压水平的影响。

方法

我们分析了来自动脉粥样硬化多族裔研究（MESA）的3015名成年人（年龄69.0±9.2岁），他们在第10年（检查5，2010 - 2012年）接受了心脏磁共振（CMR）成像检查。测量指标包括左心室（LV）参数、通过标记CMR测量的整体/局部心肌功能、通过T1映射测量（固有T1和细胞外容积分数[ECV]）的心肌间质纤维化（IMF）以及通过延迟钆增强（LGE）测量的心肌瘢痕。我们使用从基线到检查5的累积血压暴露（毫米汞柱×年）来代表长期血压水平暴露。采用线性回归、逻辑回归和广义相加模型来量化累积血压参数与心脏结构和功能测量指标之间的关联。

结果

较高的累积收缩压（SBP），独立于当前SBP，与左心室质量指数增加（每标准差增加1.93 g/m²）、整体/局部圆周应变变差（每标准差绝对值降低0.24%至0.38%）以及心肌瘢痕风险增加（比值比：1.36，95%置信区间：每标准差1.02 - 1.82）相关。累积舒张压（DBP）与圆周应变相关，在调整当前DBP后显示出近乎J形的关系（所有P < 0.05）。在血压一直低于高血压阈值的非高血压个体中，累积SBP仍与左心室质量指数和应变显著相关，但与心肌瘢痕无关（比值比：1.53，95%置信区间：0.82 - 2.87，P = 0.19）。