Adverse cardiac mechanics and incident coronary heart disease in the Cardiovascular Health Study.
Adverse cardiac mechanics and incident coronary heart disease in the Cardiovascular Health Study.
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DOI：
10.1136/heartjnl-2021-319296
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发表时间：
2022-04
期刊：
影响因子：
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通讯作者：
Shah SJ
中科院分区：
文献类型：
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作者：
Massera D;Hu M;Delaney JA;Bartz TM;Bach ME;Dvorak SJ;DeFilippi CR;Psaty BM;Gottdiener JS;Kizer JR;Shah SJ
斑点追踪超声心动图能够以比常规左心室（LV）功能障碍措施更高的灵敏度检测心脏力学异常，并可深入了解冠心病（CHD）的发病机制。我们调查了社区老年人左心室纵向应变、左心室舒张早期应变率（SR）和左心房（LA）储库应变与长期冠心病发病率的关系。在基于人群的心血管健康研究中，使用多变量考克斯比例风险模型检查了所有三种应变测量与非致死性和致死性CHD（主要结局为血运重建、非致死性和致死性心肌梗死）发生率的相关性。在10年时截断随访。我们纳入了3313名参与者（平均（SD）年龄72.6（5.5）岁）。在中位随访10.0（第25 - 75百分位数7.7-10.0）年期间，发生了439例CHD事件。校正潜在混杂因素后，左心室纵向应变（HR=1.25/SD递减，95% CI 1.09 - 1.43）和左心室舒张早期SR（HR=1.31/SD递减，95% CI 1.14 - 1.50）与CHD事件风险显著增加相关。相比之下，左心房储库应变与CHD事件无关（HR=1.06/SD递减，95%CI 0.94 - 1.19）。对心肌应激、功能障碍和重构的生化和超声心动图测量进行额外调整并没有有意义地改变这些相关性。我们发现超声心动图测量亚临床改变的左心室力学和冠心病事件之间存在关联。这些发现为亚临床LV功能障碍和CHD的基础生物学提供了信息。早期发现无症状的心肌功能不全可能为预防和早期干预提供机会。
Speckle-tracking echocardiography enables detection of abnormalities in cardiac mechanics with higher sensitivity than conventional measures of left ventricular (LV) dysfunction and may provide insight into the pathogenesis of coronary heart disease (CHD). We investigated the relationship of LV longitudinal strain, LV early diastolic strain rate (SR) and left atrial (LA) reservoir strain with long-term CHD incidence in community-dwelling older adults. The association of all three strain measures with incidence of non-fatal and fatal CHD (primary outcome of revascularisation, non-fatal and fatal myocardial infarction) was examined in the population-based Cardiovascular Health Study using multivariable Cox proportional hazards models. Follow-up was truncated at 10 years. We included 3313 participants (mean (SD) age 72.6 (5.5) years). During a median follow-up of 10.0 (25th–75th percentile 7.7–10.0) years, 439 CHD events occurred. LV longitudinal strain (HR=1.25 per SD decrement, 95% CI 1.09 to 1.43) and LV early diastolic SR (HR=1.31 per SD decrement, 95% CI 1.14 to 1.50) were associated with a significantly greater risk of incident CHD after adjustment for potential confounders. By contrast, LA reservoir strain was not associated with incident CHD (HR=1.06 per SD decrement, 95% CI 0.94 to 1.19). Additional adjustment for biochemical and echocardiographic measures of myocardial stress, dysfunction and remodelling did not meaningfully alter these associations. We found an association between echocardiographic measures of subclinically altered LV mechanics and incident CHD. These findings inform the underlying biology of subclinical LV dysfunction and CHD. Early detection of asymptomatic myocardial dysfunction may offer an opportunity for prevention and early intervention.