TY - JOUR
T1 - Regional left ventricular myocardial dysfunction as a predictor of incident cardiovascular events
T2 - MESA (Multi-Ethnic Study of Atherosclerosis)
AU - Yan, Raymond T.
AU - Bluemke, David
AU - Gomes, Antoinette
AU - Burke, Gregory
AU - Shea, Steve
AU - Liu, Kiang
AU - Bahrami, Hossein
AU - Sinha, Shantanu
AU - Wu, Colin
AU - Fernandes, Veronica
AU - McClelland, Robyn
AU - Lima, Joo A.C.
N1 - Funding Information:
This study was supported in part by National, Heart, Lung and Blood Institute grants RO1-HL66075-01 and MESA study contracts NO1-HC-95159 through NO1-HC-95168 . Dr. Yan was supported by Fellowship Awards from the Canadian Institutes of Health Research and the Detweiler Travelling Fellowship Award from the Royal College of Physicians and Surgeons of Canada . The authors have reported that they have no relationships to disclose. Kim Allan Williams, Sr, MD, served as Guest Editor for this paper.
PY - 2011/4/26
Y1 - 2011/4/26
N2 - Objectives: We sought to examine the prognostic value of subclinical left ventricular (LV) regional myocardial dysfunction (RMD) measured by magnetic resonance imaging (MRI) among asymptomatic individuals. Background: LV RMD, defined as segmental impairment in systolic wall thickening, predicts adverse events in patients with established cardiovascular disease. MRI is highly accurate for detecting subtle RMD, of which the prognostic significance in a large multiethnic asymptomatic population is not known. Methods: We used MRI to evaluate baseline regional LV myocardial function and prospectively followed a multiethnic (African American, Caucasian, Chinese, and Hispanic) population-based sample of 4,510 men and women without cardiovascular disease for a mean of 4.6 years. Regional myocardial dysfunction was defined as the presence of impaired systolic wall thickening (<10th percentile of segment-specific population distribution) in <2 contiguous LV segments within any given coronary artery territory. Results: Baseline prevalence of RMD was 25.6%. Heart failure developed in 34 (1.0%) and 30 (2.6%) participants without and with RMD, respectively (p < 0.001). After adjustment for demographics and traditional risk factors, RMD remained independently associated with incident heart failure (hazard ratio [HR]: 2.62; 95% confidence interval [CI]: 1.56 to 4.39; p < 0.001). The relationship persisted after further adjustment for biomarkers of reported association with cardiovascular disease and indexes of global LV systolic dysfunction and hypertrophy (HR: 1.80; 95% CI: 1.02 to 3.20; p = 0.044). Similarly, RMD independently conferred an increased risk for hard coronary events (myocardial infarction or death from coronary heart disease; HR: 1.75; 95% CI: 1.06 to 2.89; p = 0.029), the composite of hard coronary events and stroke (HR: 1.72; 95% CI: 1.16 to 2.56; p = 0.005), and all atherosclerotic cardiovascular events (HR: 1.50; 95% CI: 1.09 to 2.07; p = 0.012). Conclusions: Among an asymptomatic multiethnic American cohort, RMD is an independent predictor beyond traditional risk factors and global LV assessment for incident heart failure and atherosclerotic cardiovascular events. The clinical utility of early recognition of this subclinical phenotype deserves further investigation. (Multi-Ethnic Study of Atherosclerosis [MESA]; NCT00005487)
AB - Objectives: We sought to examine the prognostic value of subclinical left ventricular (LV) regional myocardial dysfunction (RMD) measured by magnetic resonance imaging (MRI) among asymptomatic individuals. Background: LV RMD, defined as segmental impairment in systolic wall thickening, predicts adverse events in patients with established cardiovascular disease. MRI is highly accurate for detecting subtle RMD, of which the prognostic significance in a large multiethnic asymptomatic population is not known. Methods: We used MRI to evaluate baseline regional LV myocardial function and prospectively followed a multiethnic (African American, Caucasian, Chinese, and Hispanic) population-based sample of 4,510 men and women without cardiovascular disease for a mean of 4.6 years. Regional myocardial dysfunction was defined as the presence of impaired systolic wall thickening (<10th percentile of segment-specific population distribution) in <2 contiguous LV segments within any given coronary artery territory. Results: Baseline prevalence of RMD was 25.6%. Heart failure developed in 34 (1.0%) and 30 (2.6%) participants without and with RMD, respectively (p < 0.001). After adjustment for demographics and traditional risk factors, RMD remained independently associated with incident heart failure (hazard ratio [HR]: 2.62; 95% confidence interval [CI]: 1.56 to 4.39; p < 0.001). The relationship persisted after further adjustment for biomarkers of reported association with cardiovascular disease and indexes of global LV systolic dysfunction and hypertrophy (HR: 1.80; 95% CI: 1.02 to 3.20; p = 0.044). Similarly, RMD independently conferred an increased risk for hard coronary events (myocardial infarction or death from coronary heart disease; HR: 1.75; 95% CI: 1.06 to 2.89; p = 0.029), the composite of hard coronary events and stroke (HR: 1.72; 95% CI: 1.16 to 2.56; p = 0.005), and all atherosclerotic cardiovascular events (HR: 1.50; 95% CI: 1.09 to 2.07; p = 0.012). Conclusions: Among an asymptomatic multiethnic American cohort, RMD is an independent predictor beyond traditional risk factors and global LV assessment for incident heart failure and atherosclerotic cardiovascular events. The clinical utility of early recognition of this subclinical phenotype deserves further investigation. (Multi-Ethnic Study of Atherosclerosis [MESA]; NCT00005487)
KW - epidemiology
KW - heart failure
KW - magnetic resonance imaging
KW - myocardial dysfunction
KW - prognosis
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U2 - 10.1016/j.jacc.2010.10.060
DO - 10.1016/j.jacc.2010.10.060
M3 - Article
C2 - 21511109
AN - SCOPUS:79955050835
SN - 0735-1097
VL - 57
SP - 1735
EP - 1744
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 17
ER -