Radiology:女性和男性的胸主动脉直径和心血管事件的发生率及死亡率之间的关系

2022-09-02 shaosai MedSci原创

尽管胸主动脉扩张是临床实践中经常发现的问题,但在人群中很少有关于其对主要心血管疾病长期预后的作用的纵向数据。

临床上发现胸部主动脉扩张通常是无症状的,然而包括夹层或破裂并发症的风险随着主动脉直径的增加而上升。因此,国际指南推荐的手术适应症主要是基于主动脉直径,并从权衡潜在的自然并发症的风险和选择性手术的风险中得出。然而,主动脉直径也随着年龄的增长而增加。血管大小和结构的变化(即血管重塑)具有系统性,涉及血液动力学和生物过程(氧化、炎症、基质降解、纤维化),在心血管疾病的发病机制中起关键作用。尽管胸主动脉扩是临床实践中经常发现的问题,但在人群中很少有关于其对主要心血管疾病长期预后的作用的纵向数据。

有限的现有纵向数据主要集中在主动脉根部,并表明主动脉根部直径与心血管疾病和死亡率有关联。只有两项研究调查了升胸主动脉(AA)或降胸主动脉(DA)与心血管事件之间的关系。此外,关于胸主动脉不同节段的扩张对不同心血管事件的长期预后价值的数据也很缺乏。因为主动脉直径与身体测量有很大关系,使用以身体测量为指数的主动脉直径可以提高其对心血管结局的预后价值。在无症状的女性和男性中评估与胸主动脉大小相关的心血管风险,可形成有效的性别特定预防策略。

近日,发表Radiology杂志的一项研究探讨了在胸部CT中心脏门控的AA和DA直径与随访期间女性和男性的心血管事件和死亡率之间的关系,为主动脉扩张的早期干预、减少并发症的发生提供了支持。

本研究对2003年至2006年期间接受多排CT检查的鹿特丹研究参与者进行了评估。进行了Cox比例危险模型来评估AA和DA直径与男性和女性的心血管事件和死亡率之间的关系,该模型以体重指数(BMI)为索引和未以体重指数为索引。主动脉直径每大1个单位的SD计算危险比(HRs)。

共有2178名参与者(平均年龄69岁;55%为女性)被纳入研究。平均随访时间为9年。BMI指数的AA直径每大0.23mm/(kg/m2),女性的心血管死亡风险就会增加33%(HR,1.33;95% CI:1.03,1.73)。BMI指数DA直径每大0.16mm/(kg/m2)与女性卒中风险高38%(HR,1.38;95%CI:1.07,1.78)和心血管死亡风险高46%(HR,1.46;95%CI:1.10,1.94)有关。在男性和女性中,较大BMI指数的AA和DA直径与较大的全因死亡风险有关。


 在女性和男性中,不同体重指数(BMI)指数的升主动脉(AA)直径四分位数的不良事件的Kaplan-Meier生存曲线。(A) BMI指数的AA直径和女性的总死亡率。(B) BMI指数的AA直径和男性的总死亡率

本研究结果表明,以体重指数为指标测量升主动脉和降主动脉的直径可以确定女性和男性的不良心血管结果和死亡的风险。

原文出处:

Oscar L Rueda-Ochoa,Lidia R Bons,Fang Zhu,et al.Thoracic Aortic Diameter and Cardiovascular Events and Mortality among Women and Men.DOI:10.1148/radiol.210861

版权声明:
本网站所有内容来源注明为“梅斯医学”或“MedSci原创”的文字、图片和音视频资料,版权均属于梅斯医学所有。非经授权,任何媒体、网站或个人不得转载,授权转载时须注明来源为“梅斯医学”。其它来源的文章系转载文章,或“梅斯号”自媒体发布的文章,仅系出于传递更多信息之目的,本站仅负责审核内容合规,其内容不代表本站立场,本站不负责内容的准确性和版权。如果存在侵权、或不希望被转载的媒体或个人可与我们联系,我们将立即进行删除处理。
在此留言
评论区 (4)
#插入话题
  1. [GetPortalCommentsPageByObjectIdResponse(id=2003995, encodeId=3176200399528, content=<a href='/topic/show?id=cdac840e95e' target=_blank style='color:#2F92EE;'>#胸主动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84079, encryptionId=cdac840e95e, topicName=胸主动脉)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b70c362, createdName=jiadan198782, createdTime=Thu Nov 10 22:52:30 CST 2022, time=2022-11-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1643814, encodeId=fcac164381424, content=<a href='/topic/show?id=6236895092b' target=_blank style='color:#2F92EE;'>#血管事件#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89509, encryptionId=6236895092b, topicName=血管事件)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f99523187183, createdName=hukaixun, createdTime=Fri Nov 11 04:52:30 CST 2022, time=2022-11-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1826817, encodeId=7e86182681e44, content=<a href='/topic/show?id=e5283e89970' target=_blank style='color:#2F92EE;'>#发生率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37899, encryptionId=e5283e89970, topicName=发生率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30bd35, createdName=一叶知秋, createdTime=Fri Oct 21 07:52:30 CST 2022, time=2022-10-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1415854, encodeId=54b0141585456, content=<a href='/topic/show?id=04812314540' target=_blank style='color:#2F92EE;'>#主动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23145, encryptionId=04812314540, topicName=主动脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=77603112682, createdName=circumcision, createdTime=Sun Sep 04 04:52:30 CST 2022, time=2022-09-04, status=1, ipAttribution=)]
  2. [GetPortalCommentsPageByObjectIdResponse(id=2003995, encodeId=3176200399528, content=<a href='/topic/show?id=cdac840e95e' target=_blank style='color:#2F92EE;'>#胸主动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84079, encryptionId=cdac840e95e, topicName=胸主动脉)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b70c362, createdName=jiadan198782, createdTime=Thu Nov 10 22:52:30 CST 2022, time=2022-11-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1643814, encodeId=fcac164381424, content=<a href='/topic/show?id=6236895092b' target=_blank style='color:#2F92EE;'>#血管事件#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89509, encryptionId=6236895092b, topicName=血管事件)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f99523187183, createdName=hukaixun, createdTime=Fri Nov 11 04:52:30 CST 2022, time=2022-11-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1826817, encodeId=7e86182681e44, content=<a href='/topic/show?id=e5283e89970' target=_blank style='color:#2F92EE;'>#发生率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37899, encryptionId=e5283e89970, topicName=发生率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30bd35, createdName=一叶知秋, createdTime=Fri Oct 21 07:52:30 CST 2022, time=2022-10-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1415854, encodeId=54b0141585456, content=<a href='/topic/show?id=04812314540' target=_blank style='color:#2F92EE;'>#主动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23145, encryptionId=04812314540, topicName=主动脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=77603112682, createdName=circumcision, createdTime=Sun Sep 04 04:52:30 CST 2022, time=2022-09-04, status=1, ipAttribution=)]
  3. [GetPortalCommentsPageByObjectIdResponse(id=2003995, encodeId=3176200399528, content=<a href='/topic/show?id=cdac840e95e' target=_blank style='color:#2F92EE;'>#胸主动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84079, encryptionId=cdac840e95e, topicName=胸主动脉)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b70c362, createdName=jiadan198782, createdTime=Thu Nov 10 22:52:30 CST 2022, time=2022-11-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1643814, encodeId=fcac164381424, content=<a href='/topic/show?id=6236895092b' target=_blank style='color:#2F92EE;'>#血管事件#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89509, encryptionId=6236895092b, topicName=血管事件)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f99523187183, createdName=hukaixun, createdTime=Fri Nov 11 04:52:30 CST 2022, time=2022-11-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1826817, encodeId=7e86182681e44, content=<a href='/topic/show?id=e5283e89970' target=_blank style='color:#2F92EE;'>#发生率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37899, encryptionId=e5283e89970, topicName=发生率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30bd35, createdName=一叶知秋, createdTime=Fri Oct 21 07:52:30 CST 2022, time=2022-10-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1415854, encodeId=54b0141585456, content=<a href='/topic/show?id=04812314540' target=_blank style='color:#2F92EE;'>#主动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23145, encryptionId=04812314540, topicName=主动脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=77603112682, createdName=circumcision, createdTime=Sun Sep 04 04:52:30 CST 2022, time=2022-09-04, status=1, ipAttribution=)]
  4. [GetPortalCommentsPageByObjectIdResponse(id=2003995, encodeId=3176200399528, content=<a href='/topic/show?id=cdac840e95e' target=_blank style='color:#2F92EE;'>#胸主动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84079, encryptionId=cdac840e95e, topicName=胸主动脉)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b70c362, createdName=jiadan198782, createdTime=Thu Nov 10 22:52:30 CST 2022, time=2022-11-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1643814, encodeId=fcac164381424, content=<a href='/topic/show?id=6236895092b' target=_blank style='color:#2F92EE;'>#血管事件#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89509, encryptionId=6236895092b, topicName=血管事件)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f99523187183, createdName=hukaixun, createdTime=Fri Nov 11 04:52:30 CST 2022, time=2022-11-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1826817, encodeId=7e86182681e44, content=<a href='/topic/show?id=e5283e89970' target=_blank style='color:#2F92EE;'>#发生率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37899, encryptionId=e5283e89970, topicName=发生率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30bd35, createdName=一叶知秋, createdTime=Fri Oct 21 07:52:30 CST 2022, time=2022-10-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1415854, encodeId=54b0141585456, content=<a href='/topic/show?id=04812314540' target=_blank style='color:#2F92EE;'>#主动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23145, encryptionId=04812314540, topicName=主动脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=77603112682, createdName=circumcision, createdTime=Sun Sep 04 04:52:30 CST 2022, time=2022-09-04, status=1, ipAttribution=)]

相关资讯

ESC 2022:长期依洛尤单抗治疗可进一步减少心血管事件(FOURIER-OLE研究)

8月29日,ESC 2022年会HOT LINE8专场发布了FOURIER-OLE试验的结果。研究显示,长期应用依洛尤单抗(evolocumab)降低低密度脂蛋白胆固醇(LDL-C)的安全性和耐受性均

Ann Rheum Dis:急性焦磷酸钙晶体关节炎患者的心血管事件风险

急性CPP晶体关节炎与非致死性CV事件的短期和长期风险升高显著相关。

NEJM:单片复方制剂能降低心肌梗死后患者心血管事件复发(SECURE试验)

心肌梗死是当前全球心衰最常见、最重要的病因之一。中国心梗后患者发病率,全因死亡率、心血管事件发生率和再住院率较高 ,这与该类患者疾病的严重性有关,也与治疗手段是否及时、恰当以及心脏科医师的疾病预防和治

JAHA:晚期糖基化终产物与心血管事件风险的关系

在老年人群中α-二羰基衍生的AGEs与CVD相关,但在更健康的中年/老年人群中则无关。该研究的结果表明,AGEs仅在显著的二羰基和氧化应激条件下才可能发挥有害的心血管作用。

Hematol Oncol:诊断为弥漫性大 B 细胞淋巴瘤并接受蒽环类药物治疗的患者心血管事件和死亡率的危险因素

老年患者、糖尿病患者和疾病晚期患者发生CVE的风险最高,后续研究应重点关注这些高危患者群体中这一常见并发症的监测和预防措施

Cardiovasc Diabetol:1型糖尿病患者的动脉僵硬度情况及其对心血管事件的预测价值

大部分没有已知心血管疾病的长病程T1D患者表现出了过早的动脉硬化