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. 2012 Dec 4;126(23):2713-9.
doi: 10.1161/CIRCULATIONAHA.112.112201. Epub 2012 Nov 2.

Prognosis of individuals with asymptomatic left ventricular systolic dysfunction in the multi-ethnic study of atherosclerosis (MESA)

Joseph Yeboah  1 , Carlos J Rodriguez, Brandon Stacey, Joao A Lima, Songtao Liu, J Jeffrey Carr, W Gregory Hundley, David M Herrington
Affiliations

Prognosis of individuals with asymptomatic left ventricular systolic dysfunction in the multi-ethnic study of atherosclerosis (MESA)

Joseph Yeboah et al. Circulation. .

Abstract

Background: Limited data exist on the prevalence, associations, and prognosis of individuals with asymptomatic left ventricular systolic dysfunction (ALVSD), especially in populations without previous clinical cardiovascular disease (CVD).

Methods and results: Kaplan-Meier and Cox proportional hazard analyses were used to assess the association between ALVSD, defined as left ventricular ejection fraction <50%, and adjudicated incident congestive heart failure (CHF), all-cause mortality, and CVD events. Of 5004 participants, 112 participants had CHF, 321 had a CVD event, and 278 died after 9 years of follow-up. The overall prevalence of ALVSD was 1.7%, with a higher prevalence in blacks (2.6%). ALVSD had a worse cardiovascular risk profile and was also associated with increased risk in unadjusted and adjusted models for incident CHF (HR [hazard ratio] [95% CI {confidence interval}]: 12.0 [7.04-20.3], P<0.0001 and 8.69 [4.89-15.45], P<0.001 respectively), CVD (HR [95% CI]: 3.32 [1.98-5.58], P<0.001 and 2.21 [1.30-3.73], P=0.003 respectively), and all-cause mortality (HR [95% CI]: 3.47 [2.03-5.94], P<0.0001 and 2.00 [1.13-3.54], P=0.017, respectively). A 10% decrement in left ventricular ejection fraction at baseline was associated with an increase in risk in unadjusted and adjusted models for clinical CHF (HR [95% CI]: 2.17 [1.82-2.63], P<0.0001 and 2.13 [1.73-2.51], P<0.001, respectively) and all-cause mortality (HR [95% CI]: 1.22 [1.05-1.41], P=0.009 and 1.17 [1.00-1.36], P=0.047, respectively). Among the subset of participants with ALVSD, the left ventricular mass index was particularly informative about risk for incident CHF (c-index=0.74).

Conclusions: ALVSD is uncommon in individuals without previous clinical CVD, but it is associated with high risk for CHF, CVD, and all-cause mortality. The left ventricular mass index had good discrimination for incident CHF in Multi-Ethnic Study of Atherosclerosis (MESA) participants with ALVSD.

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Figures

Figure 1a
Figure 1a
Kaplan Meier curves showing the event free survival of participants with asymptomatic left ventricular systolic dysfunction (ALVSD) and those without ALVSD for incident congestive heart failure after a maximum of 9 years in MESA
Figure 1b
Figure 1b
Kaplan Meier curves showing the event free survival of participants with asymptomatic left ventricular systolic dysfunction (ALVSD) and those without ALVSD for incident cardiovascular events after a maximum of 9 years in MESA
Figure 1c
Figure 1c
Kaplan Meier curves showing the event free survival of participants with asymptomatic left ventricular systolic dysfunction (ALVSD) and those without ALVSD for all cause mortality after a maximum of 9 years in MESA
Figure 2
Figure 2
Receiver operator curve showing the discrimination afforded by left ventricular mass index (LVMI) for incident congestive heart failure in the subset with asymptomatic left ventricular systolic dysfunction at 4 years of follow-up in MESA.
Figure 3
Figure 3
Receiver operator curves showing the improvement in discrimination afforded by the addition of left ventricular mass index ( LVMI) to Left ventricular ejection fraction (LVEF) for incident congestive heart failure at 4years follow up in MESA.
See this image and copyright information in PMC

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