心脏CT评估左房室耦合指数作为心血管死亡的预后标志

IF 18 Q4 Medicine

Archives of Cardiovascular Diseases Supplements Pub Date : 2023-06-01 DOI:10.1016/j.acvdsp.2023.04.044

T. Pezel , J.G. Dillinger , S. Toupin , R. Mirailles , D. Logeart , A. Cohen-Solal , T. Gonçalves , J. Lima , V. Bousson , P. Henry

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引用次数: 0

摘要

虽然心脏MRI测量的左房室耦合指数(LACI)是心血管事件的一个强有力的预测指标，但CMR在临床常规中的可用性仍然有限。因此，使用计算机断层扫描(CT)等其他成像方法来验证LACI评估是有用的。目的:探讨心脏CT评估LACI的预后价值，预测无已知CVD的连续CCTA患者CV死亡的发生。方法在2010年至2020年期间，我们开展了一项单中心研究，纳入了所有无已知心血管疾病的连续患者进行CCTA。LACI定义为左室舒张末期容积与左室容积之比。主要终点为心血管死亡。在校正传统危险因素和CCTA结果后，采用Cox回归来评估LACI与主要结局的关系。结果1444例患者(70±12岁，男性43%)中，全因死亡92例(6.4%)，其中心血管死亡67例(4.3%)，中位(IQR)随访6.8(5.9 ~ 9.1)年。在对危险因素和CCTA结果进行校正后，LACI与心血管死亡的发生呈正相关(校正危险比[HR]: 1.07 [95% CI: 1.05-1.09]每增加1%，P <0.001)，全因死亡(调整后的危险比为1.05 [95% CI: 1.03-1.07]， P <0.001)。调整后，LACI≥25%对模型判别和再分类的改善效果优于传统危险因素和CCTA结果(C-statistic improvement: 0.27;nri = 0.826;IDI = 0.209，均P <0.001;lr检验P <0.001)。结论:CCTA测量的laci与接受CCTA治疗的无已知CVD患者的心血管死亡和全因死亡独立相关，其预后价值高于传统危险因素和CCTA结果。CT对LACI的增量预后价值(图1)。

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Left atrioventricular coupling index assessed using cardiac CT as a prognostic marker of cardiovascular death

Introduction

Although the left atrioventricular coupling index (LACI) measured by Cardiac MRI is a strong predictor of CV events, the availability to CMR remains limited in clinical routine. Therefore, it would be useful to validate LACI assessment using other imaging methods such as computed tomography (CT). To investigate the prognostic value of the LACI assessed by cardiac CT, to predict the occurrence of CV death in consecutive patients without known CVD referred for CCTA.

Method

Between 2010 and 2020, we conducted a single-center study with all consecutive patients without known CVD referred for CCTA. LACI was defined as the ratio of LA to LV end-diastolic volumes. The primary outcome was cardiovascular death. Cox regressions were used to evaluate the association of LACI with the primary outcome after adjustment for traditional risk factors and CCTA findings.

Results

In 1444 patients (70 ± 12 years, 43% men), 92 (6.4%) patients experienced all-cause death, including 67 (4.3%) patients with cardiovascular death after a median (IQR) follow-up of 6.8 (5.9–9.1) years. After adjustment for risk factors and CCTA findings, LACI was positively associated with the occurrence of cardiovascular death (adjusted hazard ratio [HR]: 1.07 [95% CI: 1.05–1.09] per 1% increment, P < 0.001), and all-cause death (adjusted HR, 1.05 [95% CI: 1.03–1.07] per 1% increment, P < 0.001). After adjustment, a LACI ≥ 25% showed the best improvement in model discrimination and reclassification above traditional risk factors and CCTA findings (C-statistic improvement: 0.27; NRI = 0.826; IDI = 0.209, all P < 0.001; LR-test P < 0.001).

Conclusion

LACI measured by CCTA is independently associated with cardiovascular death and all-cause death in patients without known CVD referred for CCTA, with an incremental prognostic value over traditional risk factors and CCTA findings. Incremental prognostic value of LACI using CT (Fig. 1).

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来源期刊

Archives of Cardiovascular Diseases Supplements CARDIAC & CARDIOVASCULAR SYSTEMS-

自引率

0.00%

发文量

508

期刊介绍： Archives of Cardiovascular Diseases Supplements is the official journal of the French Society of Cardiology. The journal publishes original peer-reviewed clinical and research articles, epidemiological studies, new methodological clinical approaches, review articles, editorials, and Images in cardiovascular medicine. The topics covered include coronary artery and valve diseases, interventional and pediatric cardiology, cardiovascular surgery, cardiomyopathy and heart failure, arrhythmias and stimulation, cardiovascular imaging, vascular medicine and hypertension, epidemiology and risk factors, and large multicenter studies. Additionally, Archives of Cardiovascular Diseases also publishes abstracts of papers presented at the annual sessions of the Journées Européennes de la Société Française de Cardiologie and the guidelines edited by the French Society of Cardiology.