부산대학교 도서관

Background: Valvular heart diseases and intra-cardiac shunts associated with congenital heart disease can cause persistent disruption in the balance between left (LV) and right (RV) ventricular stroke volumes (SV). However, the prognostic value of such imbalances has not been established among asymptomatic individuals in the general population.Methods: 4,058 participants from multi-ethnic study of atherosclerosis who had a cardiac MRI at cohort inception were included in this study. ΔSV was calculated as LVSV-RVSV, and participants were classified as: Balanced ΔSV: -30 mL ≤ ΔSV ≤ 30 mL; Negative ΔSV: ΔSV < -30 mL; and Positive ΔSV: ΔSV > 30 mL. Multivariable Cox proportional hazard regression models were applied to compute hazard ratios for the association between ΔSV and mortality, heart failure (HF), and atrial fibrillation (AF).Results: The average age of participants was 61±10 years, with women making up 52% of the cohort. Participants were followed for a median of 17 years (IQR, 16.9-17.1) for AF, and 18.4 years (IQR, 18.3-18.5) for other outcomes. At baseline 1.2% of participants (n=47) had ΔSV > 30 mL, 2% (n=80) had ΔSV < -30 mL, and 96.8% (n=3931) had ΔSV between -30 and 30 mL. During follow up, 1,006 participants died, 235 incurred HF, and 764 developed AF. After adjusting for demographics and baseline cardiovascular risk factors, ΔSV > 30 mL was associated with increased mortality (HR 1.73; 95% CI 1.12-2.67; p=0.01), HF (HR 2.40; 95% CI 1.11-5.20; p=0.02), and AF (HR 1.89; 95% CI 1.16-3.08; p=0.01). These relationships were independent of LV and RV function at baseline. ΔSV < -30 mL solely linked to HF (HR 2.09, 95%CI 1.09-3.99; p=0.02) and lost significance after adjusting for baseline LV function.Conclusions: In a multi-ethnic cohort of participants free of cardiovascular disease at baseline, LVSV exceeding RVSV by at least 30 mL was independently associated with lower long-term survival and greater risk of HF and AF.