Cardiac microstructural alterations measured by echocardiography identify sex-specific risk for heart failure.
Cardiac microstructural alterations measured by echocardiography identify sex-specific risk for heart failure.
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DOI：
10.1136/heartjnl-2022-320876
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发表时间：
2022-10-28
期刊：
影响因子：
5.7
通讯作者：
Cheng, Susan
中科院分区：
文献类型：
--
作者：
Kwan, Alan;Demosthenes, Emmanuella;Salto, Gerran;Ouyang, David;Nguyen, Trevor;Nwabuo, Chike C.;Luong, Eric;Hoang, Amy;Osypiuk, Ewa;Stantchev, Plamen;Kim, Elizabeth H.;Hiremath, Pranoti;Li, Debiao;Vasan, Ramachandran;Xanthakis, Vanessa;Cheng, Susan
已建立的心力衰竭（HF）风险的临床前成像评估是基于宏观结构心脏重塑。鉴于微结构改变也可能影响HF风险，特别是在女性中，我们研究了微结构改变和HF事件之间的关联。我们研究了N=2511名成年参与者（平均年龄65.7±8.8岁，56%为女性），他们在基线时没有心血管疾病。我们采用超声心动图的纹理分析来量化微结构的改变，基于高频谱信号强度系数（HS-SIC）。我们在性别混合和性别特异性考克斯模型中研究了它与HF事件的关系，这些模型解释了传统的HF危险因素和宏观结构改变。我们在7.4±1.7年内观察到94例新发HF事件。具有较高HS-SIC的个体发生HF的风险增加（HS-SIC中HR 1.67/1-SD，95%CI 1.31至2.13; p<0.0001）。调整年龄和抗高血压药物的使用，这种关联在女性（p=0.02）中是显著的，但在男性（p=0.78）中不是。调整传统的风险因素（包括体重指数，总/高密度脂蛋白胆固醇，血压特征，糖尿病和吸烟）减弱了女性的相关性（HR 1.30，p=0.07），HS-SIC对大多数这些风险因素的HF风险具有介导作用。然而，除了这些风险因素外，在调整相对壁厚（代表宏观结构改变）后，HS-SIC与女性HF的相关性仍然显著（HR 1.47，p=0.02）。心脏微结构改变与HF风险升高相关，特别是在女性中。微结构改变可以识别性别特异性途径，个体通过这些途径从危险因素发展为临床HF。
Established preclinical imaging assessments of heart failure (HF) risk are based on macrostructural cardiac remodelling. Given that microstructural alterations may also influence HF risk, particularly in women, we examined associations between microstructural alterations and incident HF. We studied N=2511 adult participants (mean age 65.7±8.8 years, 56% women) of the Framingham Offspring Study who were free of cardiovascular disease at baseline. We employed texture analysis of echocardiography to quantify microstructural alteration, based on the high spectrum signal intensity coefficient (HS-SIC). We examined its relations to incident HF in sex-pooled and sex-specific Cox models accounting for traditional HF risk factors and macrostructural alterations. We observed 94 new HF events over 7.4±1.7 years. Individuals with higher HS-SIC had increased risk for incident HF (HR 1.67 per 1-SD in HS-SIC, 95% CI 1.31 to 2.13; p<0.0001). Adjusting for age and antihypertensive medication use, this association was significant in women (p=0.02) but not men (p=0.78). Adjusting for traditional risk factors (including body mass index, total/high-density lipoprotein cholesterol, blood pressure traits, diabetes and smoking) attenuated the association in women (HR 1.30, p=0.07), with mediation of HF risk by the HS-SIC seen for a majority of these risk factors. However, the HS-SIC association with HF in women remained significant after adjusting for relative wall thickness (representing macrostructure alteration) in addition to these risk factors (HR 1.47, p=0.02). Cardiac microstructural alterations are associated with elevated risk for HF, particularly in women. Microstructural alteration may identify sex-specific pathways by which individuals progress from risk factors to clinical HF.
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