PDF(Pubmed)
Abstract：
UNASSIGNED: It remains unknown to what extent intrinsic atrial cardiomyopathy or left ventricular diastolic dysfunction drive atrial remodeling and functional failure in heart failure with preserved ejection fraction (HFpEF). Computational 3-dimensional (3D) models fitted to cardiovascular magnetic resonance allow state-of-the-art anatomic and functional assessment, and we hypothesized to identify a phenotype linked to HFpEF.
UNASSIGNED: Patients with exertional dyspnea and diastolic dysfunction on echocardiography (E/e\', >8) were prospectively recruited and classified as HFpEF or noncardiac dyspnea based on right heart catheterization. All patients underwent rest and exercise-stress right heart catheterization and cardiovascular magnetic resonance. Computational 3D anatomic left atrial (LA) models were generated based on short-axis cine sequences. A fully automated pipeline was developed to segment cardiovascular magnetic resonance images and build 3D statistical models of LA shape and find the 3D patterns discriminant between HFpEF and noncardiac dyspnea. In addition, atrial morphology and function were quantified by conventional volumetric analyses and deformation imaging. A clinical follow-up was conducted after 24 months for the evaluation of cardiovascular hospitalization.
UNASSIGNED: Beyond atrial size, the 3D LA models revealed roof dilation as the main feature found in masked HFpEF (diagnosed during exercise-stress only) preceding a pattern shift to overall atrial size in overt HFpEF (diagnosed at rest). Characteristics of the 3D model were integrated into the LA HFpEF shape score, a biomarker to characterize the gradual remodeling between noncardiac dyspnea and HFpEF. The LA HFpEF shape score was able to discriminate HFpEF (n=34) to noncardiac dyspnea (n=34; area under the curve, 0.81) and was associated with a risk for atrial fibrillation occurrence (hazard ratio, 1.02 [95% CI, 1.01-1.04]; P=0.003), as well as cardiovascular hospitalization (hazard ratio, 1.02 [95% CI, 1.00-1.04]; P=0.043).
UNASSIGNED: LA roof dilation is an early remodeling pattern in masked HFpEF advancing to overall LA enlargement in overt HFpEF. These distinct features predict the occurrence of atrial fibrillation and cardiovascular hospitalization.
UNASSIGNED: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03260621.
UNASSIGNED: Patients with exertional dyspnea and diastolic dysfunction on echocardiography (E/e\', >8) were prospectively recruited and classified as HFpEF or noncardiac dyspnea based on right heart catheterization. All patients underwent rest and exercise-stress right heart catheterization and cardiovascular magnetic resonance. Computational 3D anatomic left atrial (LA) models were generated based on short-axis cine sequences. A fully automated pipeline was developed to segment cardiovascular magnetic resonance images and build 3D statistical models of LA shape and find the 3D patterns discriminant between HFpEF and noncardiac dyspnea. In addition, atrial morphology and function were quantified by conventional volumetric analyses and deformation imaging. A clinical follow-up was conducted after 24 months for the evaluation of cardiovascular hospitalization.
UNASSIGNED: Beyond atrial size, the 3D LA models revealed roof dilation as the main feature found in masked HFpEF (diagnosed during exercise-stress only) preceding a pattern shift to overall atrial size in overt HFpEF (diagnosed at rest). Characteristics of the 3D model were integrated into the LA HFpEF shape score, a biomarker to characterize the gradual remodeling between noncardiac dyspnea and HFpEF. The LA HFpEF shape score was able to discriminate HFpEF (n=34) to noncardiac dyspnea (n=34; area under the curve, 0.81) and was associated with a risk for atrial fibrillation occurrence (hazard ratio, 1.02 [95% CI, 1.01-1.04]; P=0.003), as well as cardiovascular hospitalization (hazard ratio, 1.02 [95% CI, 1.00-1.04]; P=0.043).
UNASSIGNED: LA roof dilation is an early remodeling pattern in masked HFpEF advancing to overall LA enlargement in overt HFpEF. These distinct features predict the occurrence of atrial fibrillation and cardiovascular hospitalization.
UNASSIGNED: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03260621.
摘要：
■在射血分数保留的心力衰竭（HFpEF）中，内在心房心肌病或左心室舒张功能障碍在多大程度上驱动心房重构和功能衰竭仍然未知。适合心血管磁共振的计算三维（3D）模型允许最先进的解剖和功能评估，我们假设鉴定与HFpEF相关的表型。
■使用超声心动图检查的劳力性呼吸困难和舒张功能障碍的患者（E/e'，>8）前瞻性招募并根据右心导管检查分类为HFpEF或非心源性呼吸困难。所有患者均接受休息和运动压力右心导管插入术和心血管磁共振检查。基于短轴电影序列生成计算3D解剖左心房(LA)模型。开发了一种全自动管道来分割心血管磁共振图像并建立LA形状的3D统计模型，并找到HFpEF和非心源性呼吸困难之间的3D模式。此外,通过常规体积分析和变形成像对心房形态和功能进行量化.24个月后进行临床随访，以评估心血管住院情况。
■超过心房大小，3DLA模型显示,在显性HFpEF(静息时诊断)模式转变为整体心房大小之前,在掩蔽HFpEF(仅在运动应激时诊断)中发现的主要特征是屋顶扩张.将3D模型的特征整合到LAHFpEF形状评分中，表征非心源性呼吸困难和HFpEF之间逐渐重塑的生物标志物。LAHFpEF形状评分能够将HFpEF（n=34）与非心源性呼吸困难（n=34；曲线下面积，0.81)，并与房颤发生的风险相关(风险比，1.02[95%CI，1.01-1.04]；P=0.003)，以及心血管住院(危险比，1.02[95%CI，1.00-1.04]；P=0.043）。
■LA屋顶扩张是掩蔽HFpEF的早期重塑模式，在明显的HFpEF中推进到整体LA扩大。这些不同的特征预测了心房颤动和心血管住院的发生。
■URL：https://www。clinicaltrials.gov；唯一标识符：NCT03260621。
■使用超声心动图检查的劳力性呼吸困难和舒张功能障碍的患者（E/e'，>8）前瞻性招募并根据右心导管检查分类为HFpEF或非心源性呼吸困难。所有患者均接受休息和运动压力右心导管插入术和心血管磁共振检查。基于短轴电影序列生成计算3D解剖左心房(LA)模型。开发了一种全自动管道来分割心血管磁共振图像并建立LA形状的3D统计模型，并找到HFpEF和非心源性呼吸困难之间的3D模式。此外,通过常规体积分析和变形成像对心房形态和功能进行量化.24个月后进行临床随访，以评估心血管住院情况。
■超过心房大小，3DLA模型显示,在显性HFpEF(静息时诊断)模式转变为整体心房大小之前,在掩蔽HFpEF(仅在运动应激时诊断)中发现的主要特征是屋顶扩张.将3D模型的特征整合到LAHFpEF形状评分中，表征非心源性呼吸困难和HFpEF之间逐渐重塑的生物标志物。LAHFpEF形状评分能够将HFpEF（n=34）与非心源性呼吸困难（n=34；曲线下面积，0.81)，并与房颤发生的风险相关(风险比，1.02[95%CI，1.01-1.04]；P=0.003)，以及心血管住院(危险比，1.02[95%CI，1.00-1.04]；P=0.043）。
■LA屋顶扩张是掩蔽HFpEF的早期重塑模式，在明显的HFpEF中推进到整体LA扩大。这些不同的特征预测了心房颤动和心血管住院的发生。
■URL：https://www。clinicaltrials.gov；唯一标识符：NCT03260621。
