Right ventricular structure is associated with the risk of heart failure and cardiovascular death: the Multi-Ethnic Study of Atherosclerosis (MESA)--right ventricle study

Abstract

Background: Changes in right ventricular (RV) morphology are associated with morbidity and mortality in heart and lung disease. We examined the association of abnormal RV structure and function with the risk of heart failure or cardiovascular death in a population-based multiethnic sample free of clinical cardiovascular disease at baseline.

Methods and results: The Multi-Ethnic Study of Atherosclerosis (MESA) performed cardiac magnetic resonance imaging on 5098 participants between 2000 and 2002 with follow-up for incident heart failure and cardiovascular death ("death") until January 2008. RV volumes and mass were available for 4204 participants. The study sample (n=4144) was 61.4±10.1 years old and 47.6% male. The presence of RV hypertrophy (increased RV mass) was associated with more than twice the risk of heart failure or death after adjustment for demographics, body mass index, education, C-reactive protein level, hypertension, and smoking status (hazard ratio, 2.52; 95% confidence interval, 1.55-4.10; P<0.001) and a doubling (or more) of risk with left ventricular mass at the mean value or lower (P for interaction=0.05).

Conclusions: RV hypertrophy was associated with the risk of heart failure or death in a multiethnic population free of clinical cardiovascular disease at baseline.

Figure 1

Study sample

Figure 2

A) Adjusted survival curves for RV hypertrophy vs normal, adjusted for age, sex, race/ethnicity, BMI, education, CRP, hypertension, and smoking status, and B) Adjusted survival curves for RV hypertrophy vs normal, adjusted for all covariates + LV mass at mean LV mass (145 g). Solid blue = RV hypertrophy, dashed red = normal RV mass. C) Interaction of RV hypertrophy with LV mass in terms of the risk of HF or death. Solid blue = estimate, solid red = 95% confidence intervals.

Figure 2

A) Adjusted survival curves for RV hypertrophy vs normal, adjusted for age, sex, race/ethnicity, BMI, education, CRP, hypertension, and smoking status, and B) Adjusted survival curves for RV hypertrophy vs normal, adjusted for all covariates + LV mass at mean LV mass (145 g). Solid blue = RV hypertrophy, dashed red = normal RV mass. C) Interaction of RV hypertrophy with LV mass in terms of the risk of HF or death. Solid blue = estimate, solid red = 95% confidence intervals.

Figure 2

A) Adjusted survival curves for RV hypertrophy vs normal, adjusted for age, sex, race/ethnicity, BMI, education, CRP, hypertension, and smoking status, and B) Adjusted survival curves for RV hypertrophy vs normal, adjusted for all covariates + LV mass at mean LV mass (145 g). Solid blue = RV hypertrophy, dashed red = normal RV mass. C) Interaction of RV hypertrophy with LV mass in terms of the risk of HF or death. Solid blue = estimate, solid red = 95% confidence intervals.

Figure 3

Adjusted survival curves for RV enlargement (RVEDV) vs normal, adjusted for A) age, sex, race/ethnicity, BMI, education, CRP, hypertension, and smoking status and B) all covariates + LVEDV. Solid blue = RV enlargement, dashed red = normal RVEDV.

Figure 3

Adjusted survival curves for RV enlargement (RVEDV) vs normal, adjusted for A) age, sex, race/ethnicity, BMI, education, CRP, hypertension, and smoking status and B) all covariates + LVEDV. Solid blue = RV enlargement, dashed red = normal RVEDV.

Figure 4

Adjusted survival curves for RV enlargement (RVESV) vs normal, adjusted for A) age, sex, race/ethnicity, BMI, education, CRP, hypertension, and smoking status and B) all covariates + LVESV. Solid blue = RV enlargement, dashed red = normal RVEDV.

Figure 4

Adjusted survival curves for RV enlargement (RVESV) vs normal, adjusted for A) age, sex, race/ethnicity, BMI, education, CRP, hypertension, and smoking status and B) all covariates + LVESV. Solid blue = RV enlargement, dashed red = normal RVEDV.