Influence of Cardiac Remodeling on Clinical Outcomes in Patients With Aortic Regurgitation
Influence of Cardiac Remodeling on Clinical Outcomes in Patients With Aortic Regurgitation
复制标题
心脏重塑对主动脉瓣关闭不全患者临床结果的影响
DOI：
10.1016/j.jacc.2023.03.001
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发表时间：
2023
影响因子：
24
通讯作者：
Elliott, Michael
中科院分区：
文献类型：
--
作者：
Malahfji, Maan;Crudo, Valentina;Kaolawanich, Yodying;Nguyen, Duc T.;Telmesani, Amr;Saeed, Mujtaba;Reardon, Michael J.;Zoghbi, William A.;Polsani, Venkateshwar;Elliott, Michael
背景：对主动脉瓣反流（AR）的定量心脏磁共振（CMR）结果的研究很少。目前尚不清楚体积测量是否比直径测量更有利。目的本研究旨在评估AR患者CMR定量阈值与预后的关系。方法在一项多中心研究中，对无症状的中度或重度AR CMR患者左室射血分数（LVEF）保留进行评估。主要结局是出现症状或LVEF下降至<50%，根据左室尺寸制定手术指导指征，或在医疗管理下死亡。次要结局与主要结局相同，不包括重塑指征的手术。我们排除了在CMR术后30天内接受手术的患者。进行了与结果相关的接受者-操作特征分析。结果我们研究了458例患者（中位年龄：60岁；IQR: 46-70岁）。在中位随访2.4年（IQR: 0.9-5.3年）期间，发生了133例事件。最佳阈值为反流容积47 mL、反流分数43%、左室收缩末指数容积43 mL/m2、左室舒张末指数容积109 mL/m2、左室直径2 cm/m2。在多变量回归分析中，iLVES容积≥43 mL/m2（HR: 2.53; 95% CI: 1.75-3.66；P< 0.001）和指标左室舒张末期容积≥109 mL/m2与预后独立相关，并提供了iLVES直径的额外判别改善，而iLVES直径与主要结局独立相关，但与次要结局无关。结论对于保留LVEF的无症状AR患者，CMR表现可用于指导治疗。与左心室直径相比，基于cmr的左心室体积评估效果更好。
BackgroundQuantitative cardiac magnetic resonance (CMR) outcome studies in aortic regurgitation (AR) are few. It is unclear if volume measurements are beneficial over diameters.ObjectivesThis study sought to evaluate the association of CMR quantitative thresholds and outcomes in AR patients.MethodsIn a multicenter study, asymptomatic patients with moderate or severe AR on CMR with preserved left ventricular ejection fraction (LVEF) were evaluated. Primary outcome was development of symptoms or decrease in LVEF to <50%, development of guideline indications for surgery based on LV dimensions, or death under medical management. Secondary outcome was the same as the primary outcome, excluding surgery for remodeling indications. We excluded patients who underwent surgery within 30 days of CMR. Receiver-operating characteristic analyses for the association with outcomes were performed.ResultsWe studied 458 patients (median age: 60 years; IQR: 46-70 years). During a median follow-up of 2.4 years (IQR: 0.9-5.3 years), 133 events occurred. Optimal thresholds were regurgitant volume of 47 mL and regurgitant fraction of 43%, indexed LV end-systolic (iLVES) volume of 43 mL/m2, indexed LV end-diastolic volume of 109 mL/m2, and iLVES diameter of 2 cm/m2. In multivariable regression analysis, iLVES volume of ≥43 mL/m2(HR: 2.53; 95% CI: 1.75-3.66;P< 0.001) and indexed LV end-diastolic volume of ≥109 mL/m2were independently associated with the outcomes and provided additional discrimination improvement over iLVES diameter, whereas iLVES diameter was independently associated with the primary outcome but not the secondary outcome.ConclusionsIn asymptomatic AR patients with preserved LVEF, CMR findings can be used to guide management. CMR-based LVES volume assessment performed favorably compared to LV diameters.