Cardiac magnetic resonance defines mechanisms of sex-based differences in outcomes following cardiac resynchronization therapy.
Cardiac magnetic resonance defines mechanisms of sex-based differences in outcomes following cardiac resynchronization therapy.
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DOI：
10.3389/fcvm.2022.1007806
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发表时间：
2022
影响因子：
3.6
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中科院分区：
文献类型：
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心脏再同步治疗（CRT）后基于性别的结果差异的机制尚不清楚。使用心脏磁共振 (CMR) 来定义 CRT 后结局中基于性别的差异机制，并根据性别和非缺血性/缺血性心肌病类型描述 CRT 候选者基于 CMR 的不同表型。在一项前瞻性研究中，根据来自 CMR、运动测试、实验室测试、心电图、合并症的 39 项基线参数，评估了三种短期 CRT 反应指标的性别差异 [CRT 后 6 个月左心室收缩末期容积指数的分数变化 (LVESVI-FC)、CRT 后 6 个月 B 型钠尿肽 (BNP)、CRT 后 6 个月峰值摄氧量的变化] 和长期生存率。条件和其他来源。 CMR 还用于通过受激回波 (DENSE) 应变成像位移编码导出周向均匀性比估计 (CURE-SVD) 参数来量化左心室机械不同步的程度。统计方法包括多变量线性回归，评估与性别和心肌病类型（缺血性和非缺血性心肌病）相关的相互作用效应以及生存分析。在 200 名患者中，54 名女性患者 (27%) 进行 CRT 前的基于 CMR 的 LVEDVI 较小 (p = 0.04)，基于验证的 CMR CURE-SVD 参数的机械不同步性较多 (p = 0.04)，晚期钆增强 (LGE) 和缺血性心肌病的频率较低 (p < 0.0001)，RVEF 较高 (p = 0.04)。 0.02），并且 LBBB 的频率更高（p = 0.01）。根据心肌病类型（缺血性/非缺血性心肌病）和性别将患者分为四组后，女性非缺血性心肌病患者的 CURE-SVD 最低（p = 0.003）、CRT 前最低 BNP 水平（p = 0.01）、CRT 后最低 BNP 水平（p = 0.05）和最有利的 LVESVI-FC（p = 0.01）。 0.001）。总体而言，女性患者在调整心肌病类型之前（p = 0.007，HR = 0.45）和调整心肌病类型之后（p = 0.009，HR = 0.67）具有更好的3年生存率。 CMR 识别出患有非缺血性和缺血性心肌病的女性 CRT 患者相对于按心肌病类型分层的男性患者的不同表型。接受 CRT 的女性心力衰竭患者更有利的短期反应和长期生存结果与基于 CMR 的左心室容积指数较低、与既往心肌梗死和 ICM 相关的疤痕存在减少以及基于 CMR 的与 CURE-SVD 的不同步程度较高相关。
Mechanisms of sex-based differences in outcomes following cardiac resynchronization therapy (CRT) are poorly understood. To use cardiac magnetic resonance (CMR) to define mechanisms of sex-based differences in outcomes after CRT and describe distinct CMR-based phenotypes of CRT candidates based on sex and non-ischemic/ischemic cardiomyopathy type. In a prospective study, sex-based differences in three short-term CRT response measures [fractional change in left ventricular end-systolic volume index 6 months after CRT (LVESVI-FC), B-type natriuretic peptide (BNP) 6 months after CRT, change in peak VO2 6 months after CRT], and long-term survival were evaluated with respect to 39 baseline parameters from CMR, exercise testing, laboratory testing, electrocardiograms, comorbid conditions, and other sources. CMR was also used to quantify the degree of left-ventricular mechanical dyssynchrony by deriving the circumferential uniformity ratio estimate (CURE-SVD) parameter from displacement encoding with stimulated echoes (DENSE) strain imaging. Statistical methods included multivariable linear regression with evaluation of interaction effects associated with sex and cardiomyopathy type (ischemic and non-ischemic cardiomyopathy) and survival analysis. Among 200 patients, the 54 female patients (27%) pre-CRT had a smaller CMR-based LVEDVI (p = 0.04), more mechanical dyssynchrony based on the validated CMR CURE-SVD parameter (p = 0.04), a lower frequency of both late gadolinium enhancement (LGE) and ischemic cardiomyopathy (p < 0.0001), a greater RVEF (p = 0.02), and a greater frequency of LBBB (p = 0.01). After categorization of patients into four groups based on cardiomyopathy type (ischemic/non-ischemic cardiomyopathy) and sex, female patients with non-ischemic cardiomyopathy had the lowest CURE-SVD (p = 0.003), the lowest pre-CRT BNP levels (p = 0.01), the lowest post-CRT BNP levels (p = 0.05), and the most favorable LVESVI-FC (p = 0.001). Overall, female patients had better 3-year survival before adjustment for cardiomyopathy type (p = 0.007, HR = 0.45) and after adjustment for cardiomyopathy type (p = 0.009, HR = 0.67). CMR identifies distinct phenotypes of female CRT patients with non-ischemic and ischemic cardiomyopathy relative to male patients stratified by cardiomyopathy type. The more favorable short-term response and long-term survival outcomes in female heart failure patients with CRT were associated with lower indexed CMR-based LV volumes, decreased presence of scar associated with prior myocardial infarction and ICM, and greater CMR-based dyssynchrony with the CURE-SVD.
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影响因子：
37.8
作者：
Sutton, MGS;Plappert, T;Hill, MRS
通讯作者：
Hill, MRS
影响因子：
13
作者：
Loring, Zak;Canos, Daniel A.;Strauss, David G.
通讯作者：
Strauss, David G.
影响因子：
3
作者：
Cipriani, Manlio;Landolina, Maurizio;Lunati, Maurizio
通讯作者：
Lunati, Maurizio
影响因子：
2.8
作者：
Mooyaart, Eline A. Q.;Marsan, Nina Ajmone;Box, Jeroen J.
通讯作者：
Box, Jeroen J.
影响因子：
158.5
作者：
Cleland, JGF;Daubert, J;Khan, NK
通讯作者：
Khan, NK