心脏磁共振成像正常参考范围的验证:动脉粥样硬化的多民族研究。

IF 6.1 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Nadine Kawel-Boehm, Spencer L Hansen, Bharath Ambale-Venkatesh, J Jeffrey Carr, J Paul Finn, Michael Jerosch-Herold, Steven M Kawut, Robyn L McClelland, Wendy Post, Martin R Prince, Steven Shea, João A C Lima, David A Bluemke
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引用次数: 0

摘要

背景:心血管影像学研究的正常参考范围通常为健康参考队列的平均值正负两倍的标准偏差(SD)(“2sd法”)。虽然广泛用于心脏磁共振(CMR),但这种方法之前尚未得到验证。本研究的目的是使用纵向队列数据来评估心脏CMR正常参考值的临床预测有效性。方法:左心室和右心室(LV和RV) CMR参数的正常参考范围来自多民族动脉粥样硬化研究(MESA)中1518名参与者(年龄45-84岁)的基线检查数据,这些参与者没有已知的CV疾病和确定的CV危险因素。以下以体表面积为指标的左室和右室参数在1和2个SDs处获得了截止值:舒张末期容积(LVEDVi, RVEDVi)、收缩末期容积(LVESVi, RVESVi)、质量(LVMi, RVMi),以及左室直径(LVEDD)、左室壁厚和射血分数(LVEF, RVEF)。然后在具有CMR数据的整个MESA队列(n=4915)中评估参考值与CV事件的关系,包括基线检查时具有CV危险因素的个体。在随访5年和10年时计算主要不良反应和所有心血管事件(分别为MACE和ACE)的Cox比例风险模型。结果:在随访5年时,LVEDVi、LVESVi和LVEF超过平均参考值2sd阈值是男性和女性MACE和ACE的预测因子(HR 2.1-4.3; P)。结论:我们的研究结果支持CMR正常参考范围与LV参数的临床相关性。大多数超过正常参考范围(2sd阈值)的左室CMR参数与5年和10年的CV风险升高相关。然而,升高的LVEDDi、RVMi、RVESVi和RVEF与CV事件无关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Validation of normal reference ranges in cardiac magnetic resonance imaging: The Multi-Ethnic Study of Atherosclerosis.

Background: Normal reference ranges in cardiovascular imaging studies are typically established as the mean value plus and minus twice the standard deviation (SD) of a healthy reference cohort ("2 SD-method"). Although widely used for cardiac magnetic resonance (CMR), this approach has not been previously validated. The purpose of this study was to use longitudinal cohort data to assess the clinical predictive validity of normal reference values for cardiac CMR.

Methods: Normal reference ranges for left- and right ventricular (LV and RV) CMR parameters were derived from baseline exam data of 1518 participants (age 45-84 years) in the Multi-Ethnic Study of Atherosclerosis (MESA) study without known CV disease and without established CV risk factors. Cut-off values at 1 and 2 SDs were obtained for the following LV and RV parameters indexed to body surface area: end-diastolic volume (LVEDVi, RVEDVi), end-systolic volume (LVESVi, RVESVi), mass (LVMi, RVMi), as well as for LVED diameter (LVEDD), LVED wall thickness and ejection fraction (LVEF, RVEF). The relationship of reference values to CV events was then evaluated in the entire MESA cohort with CMR data (n=4915), including individuals with CV risk factors at the baseline exam. Cox proportional hazard models were calculated for major adverse and all CV events (MACE and ACE, respectively) at 5 and 10 years of follow-up.

Results: At 5 years of follow-up, LVEDVi, LVESVi and LVEF beyond the 2SD-threshold of the mean reference values were predictors of MACE and ACE in men and women (HR 2.1-4.3; P <.001-.029). In men, LVMi and LVED wall thickness above the 1 SD-threshold were associated with CV events (HR 1.6-2.1; P <.001-.002). For women, LVED wall thickness above the 1 SD-threshold significantly increased risk of adverse events (HR 1.6-2.3; P.034-.002) while LVMi was associated with events only for values above the 2SD-threshold (HR 2.7-4.1; P <.001). Notably, LVEDD, RVMi, RVESVi and RVEF were not associated with CV events in men or women. CV events over 10 years showed similar trends.

Conclusions: Our results support the clinical relevance of CMR normal reference ranges for LV parameters. Most LV CMR parameters beyond the normal reference range (2SD-threshold) were associated with elevated CV risk at 5 and 10 years. Elevated LVEDDi, RVMi, RVESVi and RVEF however were not associated with CV events.

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来源期刊
CiteScore
10.90
自引率
12.50%
发文量
61
审稿时长
6-12 weeks
期刊介绍: Journal of Cardiovascular Magnetic Resonance (JCMR) publishes high-quality articles on all aspects of basic, translational and clinical research on the design, development, manufacture, and evaluation of cardiovascular magnetic resonance (CMR) methods applied to the cardiovascular system. Topical areas include, but are not limited to: New applications of magnetic resonance to improve the diagnostic strategies, risk stratification, characterization and management of diseases affecting the cardiovascular system. New methods to enhance or accelerate image acquisition and data analysis. Results of multicenter, or larger single-center studies that provide insight into the utility of CMR. Basic biological perceptions derived by CMR methods.
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