患有HFpEF的患者的病理机制和结果的肥胖相关差异:一项CMR研究
Shiro Nakamori1,2, Selcuk Kucukseymen1, Jennifer Rodriguez1
1Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA.
JACC. Advances
|June 28, 2024
概括
使用心血管磁共振 (CMR) 量化心上脂肪组织 (EAT) 和右心室 (RV) 改善了心力衰竭患者的风险分层,其中包括心力衰竭患者的保存喷射分数 (HFpEF). 对EAT和RV的综合评估为不良结果提供了附加的预后价值.
科学领域:
- 心脏病学 心脏病学
- 医疗成像医学成像
- 肥胖问题研究研究
背景情况:
- 评估心表脂肪组织 (EAT) 和右心室 (RV) 的临床意义在心力衰竭与保存的喷射分数 (HFpEF) 中仍然不清楚.
- 肥胖是HFpEF日益关注的问题,影响疾病病理生理学和患者的结果.
研究的目的:
- 研究EAT和RV量化在与肥胖相关的病理生理学中的作用.
- 评估使用心血管磁共振 (CMR) 的肥胖HFpEF患者风险分层的EAT和RV指标的潜力.
主要方法:
- 150名HFpEF患者 (73名肥胖者,77名非肥胖者) 接受CMR的回顾性分析.
- 量化EAT体积和总RV体积 (TRVV) 在终止腹透.
- 终点定义为所有原因死亡率和第一次HF住院治疗的组合,随访时间中位数为46个月.
主要成果:
- 无论肥胖状况如何,EAT作为预后生物标志物,与TRVV相关.
- 在肥胖的HFpEF患者中,EAT与RV纵向应变相关,并与左心室末端透析偏心指数的增加有关.
- 将VR量化与EAT整合,改善了肥胖人群HFpEF风险分层 (C-统计从0.70增加到0.79).
- 患有低EAT (<130毫升) 和TRVV (<180毫升) 的肥胖患者的风险低 (3.2%的年度事件率),而患有高EAT (≥130毫升) 和TRVV (≥180毫升) 的患者的风险明显更高 (11.8%的年度事件率).
结论:
- 基于CMR的EAT和RV结构量化提供了有价值的附加风险分层,用于肥胖HFpEF的不良结果.
- 对EAT和RV参数的综合评估可以识别高风险的肥胖HFpEF患者.
- 这种综合方法提高了对肥胖背景下HFpEF病理生理学的理解.
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