Adverse prognosis associated with asymmetric myocardial thickening in aortic stenosis.
Adverse prognosis associated with asymmetric myocardial thickening in aortic stenosis.
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DOI：
10.1093/ehjci/jex052
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发表时间：
2018-03-01
期刊：
影响因子：
--
通讯作者：
Dweck MR
中科院分区：
文献类型：
--
作者：
Kwiecinski J;Chin CWL;Everett RJ;White AC;Semple S;Yeung E;Jenkins WJ;Shah ASV;Koo M;Mirsadraee S;Lang CC;Mills N;Prasad SK;Jansen MA;Japp AG;Newby DE;Dweck MR
主动脉瓣狭窄患者的血管壁不对称增厚。然而，它的特点仍然很差，其预后意义尚不清楚。我们假设这种适应模式与晚期重构、左心室失代偿和预后不良有关。在一项前瞻性观察性队列研究中，166例主动脉瓣狭窄患者（年龄69岁，69%为男性，平均主动脉瓣面积1.0 ± 0.4 cm 2）和37例年龄和性别匹配的健康志愿者接受了综合临床、成像和生物标志物评价的表型表征。超声心动图和心血管磁共振显示的非对称性室壁增厚定义为局部室壁增厚≥ 13 mm且>对侧心肌节段厚度的1.5倍。虽然没有对照组患者出现不对称的室壁增厚，但使用磁共振在26%（n = 43）的主动脉瓣狭窄患者中观察到，使用超声心动图在17%（n = 29）的患者中观察到。尽管两组患者的人口统计学特征、合并症、瓣膜狭窄、心肌肥厚和纤维化相似，但非对称性室壁增厚患者的心肌肌钙蛋白I和脑利钠肽浓度升高（均P < 0.001）。在28 [22，33]个月的随访中，无论是通过磁共振[风险比（HR）= 2.15; 95%置信区间（CI）1.29-3.59; P = 0.003]还是超声心动图检测，不对称壁增厚是主动脉瓣置换术（AVR）或死亡的独立预测因子（HR = 1.79; 95% CI 1.08-3.69; P = 0.021）。不对称性室壁增厚在主动脉瓣狭窄中常见，并与心肌损伤、左心室失代偿和不良事件增加相关。它的存在可能有助于识别可能快速进行AVR的患者。 https://clinicaltrials.gov/show/NCT01755936：NCT01755936。
Asymmetric wall thickening has been described in patients with aortic stenosis. However, it remains poorly characterized and its prognostic implications are unclear. We hypothesized this pattern of adaptation is associated with advanced remodelling, left ventricular decompenzation, and a poor prognosis. In a prospective observational cohort study, 166 patients with aortic stenosis (age 69, 69% males, mean aortic valve area 1.0 ± 0.4 cm2) and 37 age and sex-matched healthy volunteers underwent phenotypic characterization with comprehensive clinical, imaging, and biomarker evaluation. Asymmetric wall thickening on both echocardiography and cardiovascular magnetic resonance was defined as regional wall thickening ≥ 13 mm and > 1.5-fold the thickness of the opposing myocardial segment. Although no control subject had asymmetric wall thickening, it was observed in 26% (n = 43) of patients with aortic stenosis using magnetic resonance and 17% (n = 29) using echocardiography. Despite similar demographics, co-morbidities, valve narrowing, myocardial hypertrophy, and fibrosis, patients with asymmetric wall thickening had increased cardiac troponin I and brain natriuretic peptide concentrations (both P < 0.001). Over 28 [22, 33] months of follow-up, asymmetric wall thickening was an independent predictor of aortic valve replacement (AVR) or death whether detected by magnetic resonance [hazard ratio (HR) = 2.15; 95% confidence interval (CI) 1.29–3.59; P = 0.003] or echocardiography (HR = 1.79; 95% CI 1.08–3.69; P = 0.021). Asymmetric wall thickening is common in aortic stenosis and is associated with increased myocardial injury, left ventricular decompenzation, and adverse events. Its presence may help identify patients likely to proceed quickly towards AVR. https://clinicaltrials.gov/show/NCT01755936: NCT01755936.
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DOI：
10.1186/1532-429x-14-50
发表时间：
2012-07-28
期刊：
Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance
影响因子：
--
作者：
Dweck MR;Joshi S;Murigu T;Gulati A;Alpendurada F;Jabbour A;Maceira A;Roussin I;Northridge DB;Kilner PJ;Cook SA;Boon NA;Pepper J;Mohiaddin RH;Newby DE;Pennell DJ;Prasad SK
通讯作者：
Prasad SK
影响因子：
37.8
作者：
MARON, BJ;CLARK, CE;EPSTEIN, SE
通讯作者：
EPSTEIN, SE
影响因子：
6.2
作者：
Lang, Roberto M.;Badano, Luigi P.;Voigt, Jens-Uwe
通讯作者：
Voigt, Jens-Uwe
影响因子：
6.4
作者：
Maceira, A. M.;Prasad, S. K.;Pennell, D. J.
通讯作者：
Pennell, D. J.
影响因子：
39.3
作者：
Chin, Calvin W. L.;Shah, Anoop S. V.;Dweck, Marc R.
通讯作者：
Dweck, Marc R.