Change in left atrial function and volume predicts incident heart failure with preserved and reduced ejection fraction: Multi-Ethnic Study of Atherosclerosis.

IF 6.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS European Heart Journal - Cardiovascular Imaging Pub Date : 2024-10-30 DOI:10.1093/ehjci/jeae138

Daniel J Lim, Vinithra Varadarajan, Thiago Quinaglia, Theo Pezel, Colin Wu, Chikara Noda, Susan R Heckbert, David Bluemke, Bharath Ambale-Venkatesh, Joao A C Lima

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Abstract

Aims: The role of change in left atrial (LA) parameters prior to the onset of heart failure (HF) remains unclear. We used cardiac magnetic resonance (CMR) imaging to investigate the relationship between longitudinal change in LA function and incident HF in a multi-ethnic population with subclinical cardiovascular disease (CVD).

Methods and results: In this prospective multi-ethnic cohort study, 2470 participants (60 ± 9 years, 47% males), free at baseline of clinical CVD, had LA volume and function assessed via multimodality tissue tracking on CMR imaging at baseline (2000-02) and a second study 9.4 ± 0.6 years later. Free of HF, 73 participants developed incident HF [HF with preserved ejection fraction (HFpEF), n = 39; reduced ejection fraction (HFrEF), n = 34] 7.1 ± 2.1 years after the second study. An annual decrease of 1 SD unit in peak LA strain (ΔLASmax) was most strongly associated with the risk of HFpEF [subdistribution hazard ratios (HR) = 2.56, 95% confidence interval (CI) (1.34-4.90), P = 0.004] and improved model reclassification and discrimination in predicting HFpEF [C-statistic = 0.84, 95% CI (0.79-0.90); net reclassification index (NRI) = 0.34, P = 0.01; and integrated discrimination index (IDI) = 0.02, P = 0.02], whilst an annual decrease of 1 mL/m2 of pre-atrial indexed LA volumes (ΔLAVipreA) was most strongly associated with the risk of HFrEF [subdistribution HR = 1.88, 95% CI (1.44-2.45), P < 0.001] and improved model reclassification and discrimination in predicting HFrEF [C-statistic = 0.81, 95% CI (0.72-0.90); NRI = 0.31, P = 0.03; and IDI = 0.01, P = 0.50] after adjusting for event-specific risk factors and baseline LA measures.

Conclusion: ΔLASmax and ΔLAVipreA were associated with and incrementally predictive of HFpEF and HFrEF, after adjusting for risk factors and baseline LA measures in this population of subclinical CVD.

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左心房功能和容积的变化可预测射血分数保留和减少的心力衰竭事件：多种族动脉粥样硬化研究》。

目的：心力衰竭（HF）发病前左心房（LA）参数变化的作用仍不清楚。我们使用心脏磁共振成像（CMR）研究了亚临床心血管疾病（CVD）多种族人群中 LA 功能纵向变化与 HF 发病之间的关系：在这项前瞻性多种族队列研究中，2470 名参与者（60 ± 9 岁，47% 为男性）在基线（2000-02 年）和 9.4 ± 0.6 年后的第二次研究中均无临床心血管疾病，并通过 CMR 成像的多模态组织追踪评估了 LA 容量和功能。73名参与者无高血压，但发生了高血压[射血分数保留型高血压（HFpEF），n = 39；射血分数降低型高血压（HFrEF），n = 34] 。第二次研究后 7.1 ± 2.1 年。LA 应变峰值（ΔLASmax）每年下降 1 个 SD 单位与 HFpEF 风险的关系最为密切[亚分布危险比 (HR) = 2.56，95% 置信区间 (CI) (1.34-4.90)，P = 0.004]，并改善了预测 HFpEF 的模型再分类和分辨能力[C-统计量 = 0.84，95% CI (0.79-0.90)；净再分类指数 (NRI) = 0.34，P = 0.01；综合分辨指数 (IDI) = 0.02，P = 0.02]，而心房前指数化 LA 容积每年减少 1 mL/m2 (ΔLAVipreA)与 HFrEF 风险最密切相关[亚分布 HR = 1.88，95% CI (1.44-2.45)，P < 0.001]，并且在调整事件特异性风险因素和基线 LA 测量后，可提高预测 HFrEF 的模型再分类和判别能力[C 统计量 = 0.81，95% CI (0.72-0.90)；NRI = 0.31，P = 0.03；IDI = 0.01，P = 0.50]。结论：在亚临床心血管疾病人群中，调整风险因素和基线 LA 测量值后，ΔLASmax 和 ΔLAVipreA 与 HFpEF 和 HFrEF 相关，并可递增预测 HFpEF 和 HFrEF。

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来源期刊

European Heart Journal - Cardiovascular Imaging CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

11.60

自引率

9.70%

发文量

708

审稿时长

4-8 weeks

期刊介绍： European Heart Journal – Cardiovascular Imaging is a monthly international peer reviewed journal dealing with Cardiovascular Imaging. It is an official publication of the European Association of Cardiovascular Imaging, a branch of the European Society of Cardiology. The journal aims to publish the highest quality material, both scientific and clinical from all areas of cardiovascular imaging including echocardiography, magnetic resonance, computed tomography, nuclear and invasive imaging. A range of article types will be considered, including original research, reviews, editorials, image focus, letters and recommendation papers from relevant groups of the European Society of Cardiology. In addition it provides a forum for the exchange of information on all aspects of cardiovascular imaging.