Demographic-Based Personalized Left Ventricular Hypertrophy Thresholds for Hypertrophic Cardiomyopathy Diagnosis.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
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Shiwani Hunain, Davies Rhodri H, Topriceanu Constantin-Cristian, Ditaranto Raffaello, Owens Anjali, Raman Betty, Augusto João, Hughes Rebecca K, Torlasco Camilla, Dowsing Ben, Artico Jessica, Joy George, Miranda Inês, Witschey Walter, Rodriguez-Palomares Jose F, Badia-Molins Clara, Crotti Lia, Cortina-Borja Mario, Chuang Michael L, Kwong Raymond Y, Kramer Christopher M, Manning Warren, Ho Carolyn Y, Kellman Peter, Hughes Alun D, Biagini Elena, Mohiddin Saidi, Lopes Luis, Litt Harold, Ferrari Victor A, Captur Gabriella, Moon James C, PRECISION-HCM Collaborative
Аннотация
METHODS: Left ventricular MWT was measured in 3 cohorts: a Reference Cohort of healthy adults (n = 5,067, no comorbidities), a Population Cohort (n = 43,239, with comorbidities), and an HCM Cohort from 6 international centers (n = 2,424). Measurement used cardiovascular magnetic resonance (CMR) and a validated artificial intelligence algorithm. The Reference Cohort was used to developed demographically adjusted LVH thresholds, and individualized z-scores based on age, sex, and body surface area (BSA), which were used to explore the other cohorts.
RESULTS: The traditional ≥15-mm threshold classified 4.3% (n = 1,854) of the Population Cohort as hypertrophic, with a significant sex skew (89% male). Demographic-adjusted LVH thresholds (range: 10-17 mm) reduced ascertainment to 2.2% (n = 945), reducing the sex skew (56% male). Similar reductions in bias with height, weight, and age also occurred. The HCM cohort was found to have a 2:1 male-to-female ratio. A significant proportion of patients received diagnoses of HCM despite having MWT below the traditional LVH threshold (<15 mm): 27% of female individuals and 18% of male individuals. Using demographic-adjusted LVH thresholds reduced these proportions to 7% of female individuals and 15% of male individuals (P < 0.0001). Female patients had lower absolute MWT (18 mm vs 19 mm; P < 0.001) but higher MWT z-scores (5.1 vs 4.5; P = 0.05).
CONCLUSIONS: Age, sex, and body size influence the normal heart MWT. Using a fixed LVH threshold ≥15 mm biases LVH ascertainment in both population and HCM cohorts. A demographic-adjusted approach for LVH improves ascertainment and diagnostic accuracy.