摘要
背景 心血管疾病目前在全球范围仍然有很高的发病率和死亡率.心内膜下心肌活力率(SEVR)是侵入性血流动力学研究中分析左心室和主动脉压力曲线引出的一个指标,是评估心肌灌注的一个有价值的工具,在不同人群的心血管不良事件和死亡率方面也具有潜在的预测价值.无创的测量方法可以估测SEVR,虽然有一定局限性,但仍然是评估心肌灌注和心血管风险的有价值的工具并显示出了巨大的临床应用潜力.目前缺乏大规模流行病学调查研究探索SEVR在心血管疾病一级和二级预防中的实际价值.目的 在北京社区人群中使用无创方法估测SEVR,并分析其相关影响因素.方法 本文基于队列研究的横断面随访,研究对象来源于北京大学第一医院心血管内科 2011年12月—2012年4月在北京市石景山区首钢社区建立的动脉粥样硬化研究队列,招募人群为年龄≥40岁的社区居民.2018年随访时采用无创方法进行脉搏波分析检查,并获得SEVR结果.采用线性回归分析探究SEVR的相关影响因素.结果 2018 年参加随访的 6 568 例研究对象中,排除因心律不齐等未能完成脉搏波分析检查获得SEVR者,最终入选6 382例,97.2%的研究对象有SEVR结果.6 382例社区居民中男2 130例、女4 252例,平均SEVR为(144±22)%.线性回归分析结果显示,在总社区居民中,性别(β=-11.00)、年龄(β=-0.53)、吸烟(β=2.36)、高血压(β=-4.12)、脂代谢紊乱(β=-1.45)、糖尿病(β=-4.36)、服用降压药(β=3.72)、降糖治疗(β=-3.71)是SEVR的独立影响因素(P<0.05).在男性居民中,年龄(β=-0.67)、高血压(β=-3.20)、脂代谢紊乱(β=-2.73)、糖尿病(β=-3.42)及降糖治疗(β=-5.07)是SEVR的独立影响因素(P<0.05).在女性居民中,年龄(β=-0.48)、吸烟(β=9.44)、高血压(β=-4.98)、糖尿病(β=-4.95)、服用降压药(β=5.26)及降糖治疗(β=-2.82)是SEVR的独立影响因素(P<0.05).结论 无创的SEVR测定在大规模社区人群的队列研究中应用是可行的.SEVR与性别、年龄、吸烟、高血压、脂代谢紊乱、糖尿病这些传统冠心病危险因素相关,其与药物治疗的关系还需要进一步研究探讨.
Abstract
Background At present,cardiovascular diseases still have a high incidence and mortality worldwide.Subendocardial viability ratio(SEVR)is calculated from the analysis of left ventricular and aortic pressure curves in invasive hemodynamic studies,serving as a valuable indicator of myocardial perfusion,and predictive factor for cardiovascular adverse events and mortality in different populations.Although having certain limitations,non-invasive measurements of SEVR are valuable tools for evaluating myocardial perfusion and assessing cardiovascular risk.However,large-scale epidemiological studies to explore the practical value of SEVR in primary and secondary prevention of cardiovascular diseases are scant.Objective This study aims to non-invasively measure SEVR in a large-scale Beijing community-based population and to identify the influencing factors.Methods It was a cross-sectional follow-up study involving a cohort of residents(≥40 years of age)with atherosclerosis in the Shougang Community,Shijingshan District,Beijing,who were treated in the Department of Cardiology,Peking University First Hospital from December 2011 to April 2012.Non-invasive SEVR measurements were conducted using Pulsepen(DiaTecne srl,San Donato Milanese,Italy)during the follow-up period in 2018.Generalized linear regression models were applied to analyze influencing factors for SEVR.Results A total of 6 568 participants followed up in 2018 were initially enrolled.After excluding those without SEVR data for arrhythmia(2.8%),6 382 eligible ones were finally included in our study.SEVR measurements were obtained from 97.2%of patients.In the cohort,there were 2 130 males and 4 252 females,with a mean SEVR of(144±22)%.The Multivariate linear regression analysis showed that sex(β=-11.00),age(β=-0.53),smoking(β=2.36),hypertension(β=-4.12),dyslipidemia(β=-1.45),diabetes(β=-4.36),antihypertensive drugs(β=3.72),and hypoglycemic treatment(β=-3.71)were independently associated with SEVR(P<0.05).In males,age(β=-0.67),hypertension(β=-3.20),dyslipidemia(β=-2.73),diabetes(β=-3.42),and hypoglycemic treatment(β=-5.07)were independent influencing factors for SEVR(P<0.05).In females,age(β=-0.48),smoking(β=9.44),hypertension(β=-4.98),diabetes(β=-4.95),antihypertensive drugs(β=5.26),and hypoglycemic treatment(β=-2.82)were independent influencing factors for SEVR(P<0.05).Conclusion Non-invasive measurement of SEVR is feasible in large-scale community-based populations.SEVR is associated with traditional risk factors,such as sex,age,smoking,hypertension,dyslipidemia,and diabetes.The relationship between SEVR and medication needs to be explored through further research.
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