■射血分数降低(HFrEF)的心力衰竭的特征是心室重塑和心肌能量受损。可以使用心血管磁共振(CMR)成像非侵入性地进行左心室压力-容积(PV)环分析,以评估心脏热力学效率。
■这项研究的目的是调查非侵入性PV环参数,源自CMR,可以预测HFrEF患者的主要不良心脏事件(MACE)。
■PV回路参数(冲程功,心室效率,外部电源,收缩性,和每个喷射体积的能量)是从CMR电影图像和肱动脉血压计算得出的。主要终点是MACE(心血管死亡,心力衰竭(HF)住院治疗,心肌梗塞,血运重建,室性心动过速/纤颤,心脏移植,或5年内植入左心室辅助装置)。使用多变量Cox回归评估PV环路参数与MACE之间的关联。
■164名HFrEF患者(左心室射血分数≤40%,年龄63[IQR:55-70]岁,79%的男性)在2004年至2014年期间接受了临床CMR检查。88例患者(54%)在平均2.8年后至少经历了一次MACE。未调整模型显示MACE与所有肺静脉环路参数之间存在显着关联(全部P<0.05),HF病因(P<0.001),左心室射血分数(P=0.003),全局纵向应变(P<0.001),和N末端脑钠肽激素原水平(P=0.001)。在校正年龄的多变量Cox回归分析中,性别,高血压,糖尿病,和HF病因,心室效率与MACE相关(HR:1.04(95%CI:1.01-1.08)百分比下降,P=0.01)。
■心室效率,来自标准CMR扫描的非侵入性PV环路分析,与HFrEF患者的MACE有关。
UNASSIGNED: Heart failure with reduced ejection fraction (HFrEF) is characterized by ventricular remodeling and impaired myocardial energetics. Left ventricular pressure-volume (PV) loop analysis can be performed noninvasively using cardiovascular magnetic resonance (CMR) imaging to assess cardiac thermodynamic efficiency.
UNASSIGNED: The aim of the study was to investigate whether
noninvasive PV loop parameters, derived from CMR, could predict major adverse cardiac events (MACE) in HFrEF patients.
UNASSIGNED: PV loop parameters (stroke work, ventricular efficiency, external power, contractility, and energy per ejected volume) were computed from CMR cine images and brachial blood pressure. The primary end point was MACE (cardiovascular death, heart failure (HF) hospitalization, myocardial infarction, revascularization, ventricular tachycardia/fibrillation, heart transplantation, or left ventricular assist device implantation within 5 years). Associations between PV loop parameters and MACE were evaluated using multivariable Cox regression.
UNASSIGNED: One hundred and sixty-four HFrEF patients (left ventricular ejection fraction ≤40%, age 63 [IQR: 55-70] years, 79% male) who underwent clinical CMR examination between 2004 and 2014 were included. Eighty-eight patients (54%) experienced at least one MACE after an average of 2.8 years. Unadjusted models demonstrated a significant association between MACE and all PV loop parameters (P < 0.05 for all), HF etiology (P < 0.001), left ventricular ejection fraction (P = 0.003), global longitudinal strain (P < 0.001), and N-terminal prohormone of brain natriuretic peptide level (P = 0.001). In the multivariable Cox regression analysis adjusted for age, sex, hypertension, diabetes, and HF etiology, ventricular efficiency was associated with MACE (HR: 1.04 (95% CI: 1.01-1.08) per-% decrease, P = 0.01).
UNASSIGNED: Ventricular efficiency, derived from
noninvasive PV loop analysis from standard CMR scans, is associated with MACE in patients with HFrEF.