Prognostic value of left ventricular mass measured on coronary computed tomography angiography.

Michael Abiragi, Melanie Chen, Billy Lin, Heidi Gransar, Damini Dey, Piotr Slomka, Sean W Hayes, Louise E Thomson, John D Friedman, Daniel S Berman, Donghee Han
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Abstract

Background: Left ventricular (LV) mass is a well-established prognostic indicator for cardiovascular risk. Measurement of LV mass on coronary computed tomography angiography (CCTA) is considered optional. We aimed to assess for associations between LV mass measured on CCTA with all-cause mortality (ACM) risk and to determine age- and sex-specific distributions.

Methods: We evaluated patients without known coronary artery disease (CAD) who underwent CCTA at a single center. We assessed age- and sex-specific distributions (10th, 25th, 50th, 75th, and 90th percentiles) of LV mass index. ACM, the primary endpoint, was recorded over a median period of 5.1 [interquartile range: 1.4-8.4] years. The association between LV mass and mortality risk was assessed using multivariable Cox models adjusted for age, sex, medical history, coronary artery calcium (CAC) score and CCTA stenosis.

Results: 4187 patients (mean age: 61.9 ​± ​11.7, 63 ​% male) were included. Male sex, African American ethnicity, Hypertension, CAC>400, and smoking were independent predictors of increased LV mass index. During the median 5.1 years of study follow, 265 (6.3 ​%) deaths occurred. Increased LV mass index percentiles were associated with increased risk of ACM. The addition of LV mass index percentiles improved discrimination and reclassification for mortality prediction over a model with age, sex, conventional risk factors, CAC score and CCTA stenosis severity (X2 improvement: 22.68, NRI: 28 ​%, both p ​< ​0.001).

Conclusion: In a large sample of patients without known CAD who underwent CCTA, increased LV mass index provided independent and incremental prognostic value for all-cause mortality. Assessment of LV mass by CCTA, considering age and gender distribution, can be utilized clinically to identify patients with high myocardial mass.

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冠状动脉计算机断层扫描血管造影测量的左心室质量的预后价值。
背景:左心室(LV)质量是一项公认的心血管风险预后指标。冠状动脉计算机断层扫描血管造影术(CCTA)可选择测量左心室质量。我们的目的是评估 CCTA 测量的左心室质量与全因死亡率(ACM)风险之间的关联,并确定年龄和性别特异性分布:我们评估了在一个中心接受 CCTA 检查的无已知冠状动脉疾病(CAD)的患者。我们评估了左心室质量指数的年龄和性别特异性分布(第 10、25、50、75 和 90 百分位数)。主要终点 ACM 的记录时间中位数为 5.1 年[四分位间范围:1.4-8.4]。采用多变量 Cox 模型评估左心室质量与死亡风险之间的关系,并对年龄、性别、病史、冠状动脉钙化(CAC)评分和 CCTA 狭窄程度进行调整:共纳入 4187 名患者(平均年龄:61.9 ± 11.7,男性占 63%)。男性、非裔美国人、高血压、CAC>400 和吸烟是左心室质量指数增加的独立预测因素。在中位 5.1 年的随访期间,共有 265 人(6.3%)死亡。左心室质量指数百分位数增加与 ACM 风险增加有关。与包含年龄、性别、常规风险因素、CAC 评分和 CCTA 狭窄严重程度的模型相比,增加左心室质量指数百分位数提高了死亡率预测的分辨力和再分类能力(X2 改善:22.68,NRI:28%,均为 p 结论:在接受 CCTA 检查的无已知 CAD 的大样本患者中,左心室质量指数的增加对全因死亡率具有独立的增量预后价值。考虑到年龄和性别分布,CCTA 对左心室质量的评估可用于临床,以识别心肌质量高的患者。
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