Correlates of echocardiographic indices of cardiac remodeling over the adult life course: longitudinal observations from the Framingham Heart Study.
Correlates of echocardiographic indices of cardiac remodeling over the adult life course: longitudinal observations from the Framingham Heart Study.
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DOI：
10.1161/circulationaha.110.937821
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发表时间：
2010-08-10
期刊：
影响因子：
37.8
通讯作者：
Vasan RS
中科院分区：
文献类型：
--
作者：
Cheng S;Xanthakis V;Sullivan LM;Lieb W;Massaro J;Aragam J;Benjamin EJ;Vasan RS
心脏在生命过程中逐渐重塑，但在社区中表征这种重塑的纵向数据有限。使用多水平模型，我们分析了4，062名Fracket研究参与者（平均年龄45岁，54%为女性; 11，485人观察）在16年期间获得的4个系列超声心动图观察结果。我们将左室壁厚度（LVWT）、左室收缩（LVDS）和舒张（LVDD）尺寸以及短轴缩短率（FS）与年龄、性别、体重指数（BMI）、血压（BP，包括抗高血压药物使用）、吸烟和糖尿病（对每种超声心动图测量进行单独分析）相关。随着年龄的增长，LV尺寸减小，而FS和LVWT随之增加。男性、BMI和BP指数/高血压治疗与较大的LV尺寸和LVWT显著相关。年龄对心脏重塑的影响受关键协变量的影响（所有相互作用的P>0.05）：女性和糖尿病患者的LVWT与年龄相关性增加更大;糖尿病或高血压的存在与年龄增加的LV舒张期尺寸减少较少相关;抗高血压药物的使用是FS随年龄增加而减弱的标志。随着年龄的增长，成年人生命过程中的心脏重塑的特征在于LVWT增加、LV尺寸减小和FS增加的独特模式。总的来说，女性、更大的血压负荷和糖尿病的存在有助于减弱这种重塑模式。这些观察结果提示舒张性心力衰竭患者中女性高血压和糖尿病患者占优势的机制。
The heart progressively remodels over the life course, yet longitudinal data characterizing such remodeling in the community are limited. Using multilevel modeling, we analyzed up to 4 serial echocardiographic observations obtained over a 16-year period in 4,062 Framingham Study participants (mean age 45 years, 54% women; 11,485 person-observations). We related LV wall thickness (LVWT), LV systolic (LVDS) and diastolic (LVDD) dimensions and fractional shortening (FS) to age, sex, body mass index (BMI), blood pressure (BP, including antihypertensive medication use), smoking, and diabetes (separate analyses for each echocardiographic measure). With advancing age, LV dimensions decreased, whereas FS and LVWT increased concomitantly. Male sex, BMI, and BP indices/hypertension treatment were significantly related to both greater LV dimensions and LVWT. The effect of age on cardiac remodeling was influenced by key covariates (P>0.05 for all interactions): women and individuals with diabetes experienced greater age-associated increases in LVWT; presence of diabetes or a higher BP was associated with a lesser decrease in LV diastolic dimensions with increasing age; antihypertensive medication use was a marker of an attenuated increase in FS with aging. Cardiac remodeling over the adult life course is characterized by a distinct pattern of increasing LVWT, decreasing LV dimensions and increasing FS with advancing age. Overall, female sex, greater BP load, and presence of diabetes serve to attenuate this remodeling pattern. These observations suggest a mechanism for the preponderance of women with hypertension and individuals with diabetes among patients with diastolic heart failure.