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Left Ventricular Structure and Risk of Cardiovascular Events: A Framingham Heart Study Cardiac Magnetic Resonance
Connie W Tsao1, Philimon N Gona2, Carol J Salton3
1Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (C.W.T., C.J.S., W.J.M., C.J.D.) Framingham Heart Study, Framingham, MA (C.W.T., P.N.G., M.L.C., D.L., C.J.D.).
Insights
Elevated left ventricular mass index (LVMI) and concentric remodeling predict cardiovascular disease (CVD) events. These factors improve CVD risk prediction, highlighting potential for primary prevention strategies.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Preventive Cardiology
Background:
- Elevated left ventricular mass index (LVMI) and concentric left ventricular (LV) remodeling are linked to adverse cardiovascular disease (CVD) events.
- The predictive value of LV concentric remodeling and LV mass for CVD events is not well understood.
Purpose of the Study:
- To assess the predictive utility of LVMI and LV concentric remodeling for incident CVD events.
- To evaluate the improvement in CVD risk prediction by incorporating LVMI and concentricity measures.
Main Methods:
- Analysis of Framingham Heart Study Offspring Cohort members without prevalent CVD (n=1715).
- Cardiovascular magnetic resonance imaging (CMR) used to assess LVMI and geometry.
- Prospective follow-up for incident CVD events and CVD death over a median of 8.4 years.
Main Results:
- Each 10-g/m(2) increase in LVMI was associated with a 33% increased CVD risk (P=0.004).
- Each 0.1 unit increase in relative wall thickness was associated with a 59% increased CVD risk (P=0.009).
- Incorporating LVMI and relative wall thickness modestly improved CVD risk prediction (C-statistic increased from 0.71 to 0.74).
Conclusions:
- Greater LVMI and LV concentric hypertrophy are associated with a significantly increased risk of adverse incident CVD events in adults without prevalent CVD.
- Further investigation is needed to determine the benefits of primary prevention strategies targeting LV mass and geometry.
Background:
Elevated left ventricular mass index (LVMI) and concentric left ventricular (LV) remodeling are related to adverse cardiovascular disease (CVD) events. The predictive utility of LV concentric remodeling and LV mass in the prediction of CVD events is not well characterized.
Methods And Results:
Framingham Heart Study Offspring Cohort members without prevalent CVD (n=1715, 50% men, aged 65±9 years) underwent cardiovascular magnetic resonance for LVMI and geometry (2002-2006) and were prospectively followed for incident CVD (myocardial infarction, coronary insufficiency, heart failure, stroke) or CVD death. Over 13 808 person-years of follow-up (median 8.4, range 0.0 to 10.5 years), 85 CVD events occurred. In multivariable-adjusted proportional hazards regression models, each 10-g/m(2) increment in LVMI and each 0.1 unit in relative wall thickness was associated with 33% and 59% increased risk for CVD, respectively (P=0.004 and P=0.009, respectively). The association between LV mass/LV end-diastolic volume and incident CVD was borderline significant (P=0.053). Multivariable-adjusted risk reclassification models showed a modest improvement in CVD risk prediction with the incorporation of cardiovascular magnetic resonance LVMI and measures of LV concentricity (C-statistic 0.71 [95% CI 0.65 to 0.78] for the model with traditional risk factors only, improved to 0.74 [95% CI 0.68 to 0.80] for the risk factor model additionally including LVMI and relative wall thickness).
Conclusions:
Among adults free of prevalent CVD in the community, greater LVMI and LV concentric hypertrophy are associated with a marked increase in adverse incident CVD events. The potential benefit of aggressive primary prevention to modify LV mass and geometry in these adults requires further investigation.
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