Prognostic implications of left ventricular dyssynchrony for major adverse cardiovascular events in asymptomatic women and men: The Multi-Ethnic Study of Atherosclerosis

Ravi K. Sharma, Gustavo Volpe, Boaz D. Rosen, Bharath Ambale Venkatesh, Sirisha Donekal, Veronica Fernandes, Colin O. Wu, Jeffrey Carr, David A. Bluemke, Joao Lima

Research output: Contribution to journalArticle

Abstract

Background: Left ventricular (LV) dyssynchrony is related to adverse outcomes in systolic heart failure, but its prognostic importance in asymptomatic population is not known. Our objective was to assess the prognostic implications of LV mechanical dyssynchrony in a large multiethnic population before the occurrence of global LV dysfunction. Methods and Results: A total of 1392 participants in the Multi-Ethnic Study of Atherosclerosis (MESA; mean age: 64.7 years; 46% were women) with cardiac magnetic resonance imaging at baseline were followed for a median duration of 8.3 years. Harmonic phase imaging analysis was used to derive systolic circumferential strain. Greater standard deviation of time to peak systolic strain (SD-TPS) indicates greater dyssynchrony. With SD-TPS as a continuous variable, Cox proportional hazards analysis was used to assess hazards ratio after adjusting for demographics, cardiovascular risk factors, LV mass-to-volume ratio, and ejection fraction. Using the 75th percentile of SD-TPS as a cutoff, Kaplan-Meier analysis was performed between 2 categorical groups for each gender. Higher values of dyssynchrony in women predicted major adverse cardiovascular events, defined as myocardial infarction, heart failure, stroke, and death (hazard ratio: 1.01 per 1-ms increment in SD-TPS, P=0.015), hard coronary events (hazard ratio: 1.05 per 1-ms increment in SD-TPS, P=0.026), and cerebrovascular events (hazard ratio: 1.03 per 1-ms increment in SD-TPS, P=0.013). In contrast, dyssynchrony in men was not predictive of events. Kaplan-Meier analyses in women revealed increased event occurrence in the higher dyssynchrony group, but this was not the case in men. Conclusions: In an asymptomatic cohort, greater LV dyssynchrony determined by cardiac magnetic resonance imaging predicts adverse cardiovascular outcome in women but not in men.

Original languageEnglish (US)
Article numbere000975
JournalJournal of the American Heart Association
Volume3
Issue number4
DOIs
StatePublished - 2014

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Atherosclerosis
Kaplan-Meier Estimate
Magnetic Resonance Imaging
Systolic Heart Failure
Left Ventricular Dysfunction
Population
Heart Failure
Stroke
Myocardial Infarction
Demography

Keywords

  • Cardiac magnetic resonance imaging
  • Cardiovascular events
  • Left ventricular dyssynchrony
  • Prognosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Prognostic implications of left ventricular dyssynchrony for major adverse cardiovascular events in asymptomatic women and men : The Multi-Ethnic Study of Atherosclerosis. / Sharma, Ravi K.; Volpe, Gustavo; Rosen, Boaz D.; Ambale Venkatesh, Bharath; Donekal, Sirisha; Fernandes, Veronica; Wu, Colin O.; Carr, Jeffrey; Bluemke, David A.; Lima, Joao.

In: Journal of the American Heart Association, Vol. 3, No. 4, e000975, 2014.

Research output: Contribution to journalArticle

Sharma, Ravi K. ; Volpe, Gustavo ; Rosen, Boaz D. ; Ambale Venkatesh, Bharath ; Donekal, Sirisha ; Fernandes, Veronica ; Wu, Colin O. ; Carr, Jeffrey ; Bluemke, David A. ; Lima, Joao. / Prognostic implications of left ventricular dyssynchrony for major adverse cardiovascular events in asymptomatic women and men : The Multi-Ethnic Study of Atherosclerosis. In: Journal of the American Heart Association. 2014 ; Vol. 3, No. 4.
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abstract = "Background: Left ventricular (LV) dyssynchrony is related to adverse outcomes in systolic heart failure, but its prognostic importance in asymptomatic population is not known. Our objective was to assess the prognostic implications of LV mechanical dyssynchrony in a large multiethnic population before the occurrence of global LV dysfunction. Methods and Results: A total of 1392 participants in the Multi-Ethnic Study of Atherosclerosis (MESA; mean age: 64.7 years; 46{\%} were women) with cardiac magnetic resonance imaging at baseline were followed for a median duration of 8.3 years. Harmonic phase imaging analysis was used to derive systolic circumferential strain. Greater standard deviation of time to peak systolic strain (SD-TPS) indicates greater dyssynchrony. With SD-TPS as a continuous variable, Cox proportional hazards analysis was used to assess hazards ratio after adjusting for demographics, cardiovascular risk factors, LV mass-to-volume ratio, and ejection fraction. Using the 75th percentile of SD-TPS as a cutoff, Kaplan-Meier analysis was performed between 2 categorical groups for each gender. Higher values of dyssynchrony in women predicted major adverse cardiovascular events, defined as myocardial infarction, heart failure, stroke, and death (hazard ratio: 1.01 per 1-ms increment in SD-TPS, P=0.015), hard coronary events (hazard ratio: 1.05 per 1-ms increment in SD-TPS, P=0.026), and cerebrovascular events (hazard ratio: 1.03 per 1-ms increment in SD-TPS, P=0.013). In contrast, dyssynchrony in men was not predictive of events. Kaplan-Meier analyses in women revealed increased event occurrence in the higher dyssynchrony group, but this was not the case in men. Conclusions: In an asymptomatic cohort, greater LV dyssynchrony determined by cardiac magnetic resonance imaging predicts adverse cardiovascular outcome in women but not in men.",
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T1 - Prognostic implications of left ventricular dyssynchrony for major adverse cardiovascular events in asymptomatic women and men

T2 - The Multi-Ethnic Study of Atherosclerosis

AU - Sharma, Ravi K.

AU - Volpe, Gustavo

AU - Rosen, Boaz D.

AU - Ambale Venkatesh, Bharath

AU - Donekal, Sirisha

AU - Fernandes, Veronica

AU - Wu, Colin O.

AU - Carr, Jeffrey

AU - Bluemke, David A.

AU - Lima, Joao

PY - 2014

Y1 - 2014

N2 - Background: Left ventricular (LV) dyssynchrony is related to adverse outcomes in systolic heart failure, but its prognostic importance in asymptomatic population is not known. Our objective was to assess the prognostic implications of LV mechanical dyssynchrony in a large multiethnic population before the occurrence of global LV dysfunction. Methods and Results: A total of 1392 participants in the Multi-Ethnic Study of Atherosclerosis (MESA; mean age: 64.7 years; 46% were women) with cardiac magnetic resonance imaging at baseline were followed for a median duration of 8.3 years. Harmonic phase imaging analysis was used to derive systolic circumferential strain. Greater standard deviation of time to peak systolic strain (SD-TPS) indicates greater dyssynchrony. With SD-TPS as a continuous variable, Cox proportional hazards analysis was used to assess hazards ratio after adjusting for demographics, cardiovascular risk factors, LV mass-to-volume ratio, and ejection fraction. Using the 75th percentile of SD-TPS as a cutoff, Kaplan-Meier analysis was performed between 2 categorical groups for each gender. Higher values of dyssynchrony in women predicted major adverse cardiovascular events, defined as myocardial infarction, heart failure, stroke, and death (hazard ratio: 1.01 per 1-ms increment in SD-TPS, P=0.015), hard coronary events (hazard ratio: 1.05 per 1-ms increment in SD-TPS, P=0.026), and cerebrovascular events (hazard ratio: 1.03 per 1-ms increment in SD-TPS, P=0.013). In contrast, dyssynchrony in men was not predictive of events. Kaplan-Meier analyses in women revealed increased event occurrence in the higher dyssynchrony group, but this was not the case in men. Conclusions: In an asymptomatic cohort, greater LV dyssynchrony determined by cardiac magnetic resonance imaging predicts adverse cardiovascular outcome in women but not in men.

AB - Background: Left ventricular (LV) dyssynchrony is related to adverse outcomes in systolic heart failure, but its prognostic importance in asymptomatic population is not known. Our objective was to assess the prognostic implications of LV mechanical dyssynchrony in a large multiethnic population before the occurrence of global LV dysfunction. Methods and Results: A total of 1392 participants in the Multi-Ethnic Study of Atherosclerosis (MESA; mean age: 64.7 years; 46% were women) with cardiac magnetic resonance imaging at baseline were followed for a median duration of 8.3 years. Harmonic phase imaging analysis was used to derive systolic circumferential strain. Greater standard deviation of time to peak systolic strain (SD-TPS) indicates greater dyssynchrony. With SD-TPS as a continuous variable, Cox proportional hazards analysis was used to assess hazards ratio after adjusting for demographics, cardiovascular risk factors, LV mass-to-volume ratio, and ejection fraction. Using the 75th percentile of SD-TPS as a cutoff, Kaplan-Meier analysis was performed between 2 categorical groups for each gender. Higher values of dyssynchrony in women predicted major adverse cardiovascular events, defined as myocardial infarction, heart failure, stroke, and death (hazard ratio: 1.01 per 1-ms increment in SD-TPS, P=0.015), hard coronary events (hazard ratio: 1.05 per 1-ms increment in SD-TPS, P=0.026), and cerebrovascular events (hazard ratio: 1.03 per 1-ms increment in SD-TPS, P=0.013). In contrast, dyssynchrony in men was not predictive of events. Kaplan-Meier analyses in women revealed increased event occurrence in the higher dyssynchrony group, but this was not the case in men. Conclusions: In an asymptomatic cohort, greater LV dyssynchrony determined by cardiac magnetic resonance imaging predicts adverse cardiovascular outcome in women but not in men.

KW - Cardiac magnetic resonance imaging

KW - Cardiovascular events

KW - Left ventricular dyssynchrony

KW - Prognosis

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