Left atrial structure and function and clinical outcomes in the general population
Left atrial structure and function and clinical outcomes in the general population
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DOI：
10.1093/eurheartj/ehs188
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发表时间：
2013-01-01
影响因子：
39.3
通讯作者：
Drazner, Mark H.
中科院分区：
文献类型：
--
作者：
Gupta, Sachin;Matulevicius, Susan A.;Drazner, Mark H.
左心房（LA）结构和功能异常可能是亚临床表型，它确定个人在不良outcome. MaximumLA容积（LAmax）和LA排空分数（LAEF）增加的风险通过心脏磁共振成像测量在达拉斯心脏研究的1802名参与者。采用线性回归分析评估了以体表面积（LAmax/BSA）为指数的LAEF和LAmax与传统危险因素、利钠肽水平、左心室（LV）结构[舒张末期容积（EDV）和同心度（0.67）（质量/EDV 0.67）]和功能（射血分数）的相关性。使用考克斯比例风险模型评估LAmax/BSA和LAEF超出传统风险因素、LV射血分数和LV质量的增量预后价值。LAmax/BSA增加和LAEF降低均与高血压和利钠肽水平相关（P均0.05）。在多变量分析中，LAmax/BSA与LV舒张末期容积/BSA最强相关，而LAEF与LV射血分数和同心度（0.67）强相关。在8.1年的中位随访期间，共有81例死亡。LAEF降低[每1个标准差（SD）的风险比（HR）（8.0）：1.56（1.321.87）]但LAmax/BSA未增加[每1个SD的HR（8.6 mL/m2）：1.14（0.971.34）]与死亡率独立相关。此外，将LAEF添加到调整了心脏病风险评分、糖尿病、种族、LV质量和射血分数的模型中，改善了c-统计量（c-统计量：分别为0.78 vs. 0.77; P 0.05），而添加LAmax/BSA没有在一般人群中，LAmax/BSA和LAEF均为重要的亚临床表型，但LAEF优于LAmax/BSA，且增量大于LAmax/BSA。
Left atrial (LA) structural and functional abnormalities may be subclinical phenotypes, which identify individuals at increased risk of adverse outcomes.Maximum LA volume (LAmax) and LA emptying fraction (LAEF) were measured via cardiac magnetic resonance imaging in 1802 participants in the Dallas Heart Study. The associations of LAEF and LAmax indexed to body surface area (LAmax/BSA) with traditional risk factors, natriuretic peptide levels, and left ventricular (LV) structure [end-diastolic volume (EDV) and concentricity(0.67) (mass/EDV0.67)] and function (ejection fraction) were assessed using linear regression analysis. The incremental prognostic value of LAmax/BSA and LAEF beyond traditional risk factors, LV ejection fraction, and LV mass was assessed using the Cox proportional-hazards model. Both increasing LAmax/BSA and decreasing LAEF were associated with hypertension and natriuretic peptide levels (P 0.05 for all). In multivariable analysis, LAmax/BSA was most strongly associated with LV end-diastolic volume/BSA, while LAEF was strongly associated with LV ejection fraction and concentricity(0.67). During a median follow-up period of 8.1 years, there were 81 total deaths. Decreasing LAEF [hazard ratio (HR) per 1 standard deviation (SD) (8.0): 1.56 (1.321.87)] but not increasing LAmax/BSA [HR per 1 SD (8.6 mL/m(2)): 1.14 (0.971.34)] was independently associated with mortality. Furthermore, the addition of LAEF to a model adjusting Framingham risk score, diabetes, race, LV mass, and ejection fraction improved the c-statistic (c-statistics: 0.78 vs. 0.77; P 0.05, respectively), whereas the addition of LAmax/BSA did not (c-statistics: 0.76, P 0.20).In the general population, both LAmax/BSA and LAEF are important subclinical phenotypes but LAEF is superior and incremental to LAmax/BSA.