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. 2019 May 1;20(5):533-540.
doi: 10.1093/ehjci/jey123.

Left ventricular global function index predicts incident heart failure and cardiovascular disease in young adults: the coronary artery risk development in young adults (CARDIA) study

Chike C Nwabuo  1   2 , Henrique T Moreira  2   3 , Henrique D Vasconcellos  2 , Nathan Mewton  2 , Anders Opdahl  4 , Kofo O Ogunyankin  5 , Bharath Ambale-Venkatesh  2 , Pamela J Schreiner  6 , Anderson A C Armstrong  2 , Cora E Lewis  7 , David R Jacobs  6 , Donald Lloyd-Jones  5 , Samuel S Gidding  8 , João A C Lima  2
Affiliations

Left ventricular global function index predicts incident heart failure and cardiovascular disease in young adults: the coronary artery risk development in young adults (CARDIA) study

Chike C Nwabuo et al. Eur Heart J Cardiovasc Imaging. .

Abstract

Aims: Left ventricular (LV) ejection fraction (LVEF) is an extensively utilized marker of LV function that is often interpreted without recourse to alterations in LV geometry and hypertrophy. LV global function index (LVGFI) is a novel marker that incorporates LV structure in the assessment of LV cardiac performance. We evaluated the prognostic utility of LVGFI from young adulthood into middle age for incident heart failure (HF) and cardiovascular disease (CVD) in comparison to LVEF.

Methods and results: Included were 4107 CARDIA participants with echocardiograms in Year-5 (1990-1991). LVGFI was defined as LV stroke volume/LV global volume*100, where LV global volume was the sum of the LV mean cavity volume ((LV end-diastolic volume + LV end-systolic volume)/2) and myocardial volume (LV mass/density). Adjusted Cox proportional hazard models were utilized to predict incident HF and CVD outcomes. Mean age of participants was 29.8 ± 3.7 years, 55% female, and 48.7% black. Higher body mass index [beta coefficient (B) = -0.11 standard error (SE) = 0.02, P < 0.001], higher blood pressure (B = -0.04, SE = 0.01, P < 0.01), smoking (B = -0.82, SE = 0.22, P < 0.001), male sex (P < 0.001), and black race (P < 0.001) were associated with worse LVGFI. A total of 207 incident CVD events were observed over the course of 98 035 person-years at risk. Higher LVGFI was associated with HF, hazard ratio (HR) = 0.70, 95% confidence interval (CI) (0.54-0.91), hard CVD HR = 0.83, 95% CI (0.71-0.96), and all CVD HR = 0.83, 95% CI (0.72-0.96). For HF outcomes, Harrell's C-statistic for LVGFI (0.80) was greater than LVEF (0.66).

Conclusion: LVGFI is a strong, independent predictor of incident HF and CVD that provides incremental prognostic value compared with LVEF. Male sex, black race, obesity, hypertension, and smoking are associated with worse LVGFI in the early adult lifespan.

Keywords: cardiac function; cardiac structure; early adulthood; heart failure; left ventricular ejection fraction; left ventricular systolic function.

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Figures

Figure 1
Figure 1
Normal distribution of left ventricular global function index, percentage for M-mode and 2D echocardiography.
Figure 2
Figure 2
Nelson–Aalen cumulative hazard estimates for all cardiovascular disease (above) and heart failure, respectively by quartiles of LVGFI (%). Lower LVGFI represents worse function. LVGFI, left ventricular global function index.
Figure 3
Figure 3
Receiver-operating characteristics showing the area under the curves for heart failure (above) and all cardiovascular disease (below), using M-mode and 2D-echocardiography. Blue line represents left ventricular ejection fraction and red line represents left ventricular global function index.
See this image and copyright information in PMC

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