Pedal Edema as an Indicator of Early Heart Failure in the Community: Prevalence and Associations With Cardiac Structure/Function and Natriuretic Peptides (MESA [Multiethnic Study of Atherosclerosis]).
Pedal Edema as an Indicator of Early Heart Failure in the Community: Prevalence and Associations With Cardiac Structure/Function and Natriuretic Peptides (MESA [Multiethnic Study of Atherosclerosis]).
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足部水肿作为社区早期心力衰竭的指标：患病率以及与心脏结构/功能和利尿钠肽的关联（MESA [动脉粥样硬化的多种族研究]）。
DOI：
10.1161/circheartfailure.116.003415
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发表时间：
2016
期刊：
影响因子：
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通讯作者：
Shah,SanjivJ
中科院分区：
文献类型：
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作者：
Yeboah,Joseph;Bertoni,Alain;Qureshi,Waqas;Aggarwal,Shivani;Lima,JoaoAC;Kawel-Boehm,Nadine;Bluemke,DavidA;Shah,SanjivJ
背景：足部水肿（PE）的患病率及其与心脏结构/功能异常、利钠肽和心力衰竭（HF）的关系尚不清楚，特别是在没有心血管疾病史的社区居民中。方法和结果在5004名接受心脏磁共振成像的MESA（多民族动脉粥样硬化研究）参与者中，有4196名数据完整并被纳入本分析（3501名用于右心室分析）。采用Logistic回归和Cox比例风险分析来评估自我报告的PE、2枕直立呼吸、阵发性夜间呼吸困难、左右心室结构和功能、利钠肽水平和心衰发生率之间的关系。28%的参与者存在体育锻炼。PE与明显的左室或右室收缩功能障碍（射血分数<50%）无关。在调整后的模型中，PE与2枕直眠（优势比1.66；95%可信区间[CI]， 1.30-2.12）、阵发性夜间呼吸困难（优势比1.95;95% CI, 1.55-2.44）和n端前b型利钠肽水平异常（定义为>400 pg/mL；优势比1.80;95% CI, 1.21-2.68）相关。在平均10.2年的随访后，184/4196（4.4%）参与者有确定的心衰住院事件。在校正了年龄、性别和种族的模型中，PE与心衰住院事件相关（风险比1.44;95% CI, 1.05-1.97）。在加入其他协变量后，包括合共病、基线左室射血分数和既往心肌梗死（风险比1.43;95% CI, 1.02-1.99），这种关联仍然存在。通过进一步调整n端前b型利钠肽，PE与HF的相关性减弱。结论spe在无临床心血管疾病的社区成年人中普遍存在，并与未来住院HF相关。
BackgroundThe prevalence of pedal edema (PE) and its associations with abnormal cardiac structure/function, natriuretic peptides, and incident heart failure (HF) is unknown, especially in community-dwelling adults without a history of cardiovascular disease.Methods and ResultsOut of 5004 MESA (Multiethnic Study of Atherosclerosis) participants who had cardiac magnetic resonance imaging, 4196 had complete data and were included in this analysis (3501 for the right ventricle analysis). Logistic regression and Cox proportional hazard analyses were used to assess the associations among self-reported PE, 2-pillow orthopnea, paroxysmal nocturnal dyspnea, left and right ventricular structure and function, natriuretic peptide levels, and incident HF. PE was present in 28% of the participants. PE was not associated with overt left or right ventricular systolic dysfunction (ejection fraction <50%). PE was associated with 2-pillow orthopnea (odds ratio 1.66; 95% confidence interval [CI], 1.30–2.12), paroxysmal nocturnal dyspnea (odds ratio 1.95; 95% CI, 1.55–2.44), and abnormal N-terminal pro-B-type natriuretic peptide levels (defined as >400 pg/mL; odds ratio 1.80; 95% CI, 1.21–2.68) in adjusted models. After a mean of 10.2 years of follow-up, 184/4196 (4.4%) participants had an adjudicated incident HF hospitalization. PE was associated with incident HF hospitalization in models adjusted for age, sex, and race (hazard ratio 1.44; 95% CI, 1.05–1.97). This association persisted after adding additional covariates, including comorbidities, baseline left ventricular ejection fraction, and antecedent myocardial infarction (hazard ratio 1.43; 95% CI, 1.02–1.99). The association of PE with incident HF was attenuated by further adjustment for N-terminal pro-B-type natriuretic peptide.ConclusionsPE is prevalent in community-dwelling adults without clinically recognized cardiovascular disease and associated with future hospitalized HF.