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Published on: April 8, 2013
Left Ventricular Wall Stress and Incident Heart Failure in Elderly Community-Dwelling Individuals
Audrey White1, Debra D Dixon2,3, Vineet Agrawal2,3,4
1Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Insights
Increased left ventricular end-diastolic wall stress (LVEDWS) is linked to a higher risk of developing heart failure (HF) in older adults. This finding highlights LVEDWS as a potential predictor for incident heart failure.
Area of Science:
- Cardiology
- Cardiovascular Research
- Heart Failure Research
Background:
- Elevated left ventricular (LV) wall stress is known to correlate with adverse outcomes in patients with existing heart failure (HF).
- The relationship between LV wall stress and the development of new-onset (incident) HF is less understood.
Purpose of the Study:
- To identify clinical factors associated with LV wall stress.
- To investigate the association between LV wall stress and the risk of incident HF.
Main Methods:
- Analysis of 4,601 Atherosclerosis Risk In Communities (ARIC) study participants without prevalent HF.
- Echocardiography-derived LV end-systolic and end-diastolic wall stress (LVESWS, LVEDWS) calculated using cardiac dimensions, blood pressure, and E/e' ratio.
- Incident HF ascertained via ICD claims, with Cox regression used for association analysis, adjusted for multiple covariates.
Main Results:
- A median follow-up of 4.6 years revealed 156 HF events.
- Each 1 kdyne/cm² increase in LVEDWS was significantly associated with a higher risk of incident HF (HR: 1.03; 95% CI: 1.01-1.06).
- LVESWS did not show a significant association with incident HF risk.
Conclusions:
- In community-dwelling elderly individuals, higher LVEDWS is a significant predictor of incident HF.
- This suggests LVEDWS may serve as a valuable biomarker for identifying individuals at risk of developing heart failure.
Background:
Greater left ventricular (LV) wall stress is associated with adverse outcomes among patients with prevalent heart failure (HF). Less is known about the association between LV wall stress and incident HF.
Objectives:
The purpose of the study was to identify clinical factors associated with wall stress and test the association between wall stress and incident HF.
Methods:
We studied 4,601 ARIC (Atherosclerosis Risk In Communities) study participants without prevalent HF who underwent echocardiography between 2011 and 2013. LV end systolic and diastolic wall stress (LVESWS, LVEDWS) were calculated from chamber and wall thickness, systemic blood pressure, and transmitral Doppler E/e' as a surrogate for LV end diastolic pressure. Incident HF was ascertained by International Classification of Diseases (ICD)-9/10 claims for hospitalized HF through December 31, 2016. We used Cox regression to test the association between wall stress and incident HF, adjusted for demographics, traditional cardiovascular risk factors, prevalent coronary artery disease and atrial fibrillation, creatinine, N-terminal pro-B-type natriuretic peptide, troponin, triglycerides, C-reactive protein, LV ejection fraction, and LV mass.
Results:
The cohort had a median age of 75 years and 58% women, with 18% identifying as Black. Median LVESWS and LVEDWS were 48.8 (25th-75th percentile: 39.3-60.1) and 18.9 (25th-75th percentile: 15.8-22.5) kdynes/cm2, respectively. LVESWS and LVEDWS were modestly related (rho = 0.30, P < 0.001). Over 4.6 years of median follow-up (156 HF events), each 1 kdyne/cm2 greater LVEDWS was significantly associated with higher risk of incident HF (HR: 1.03; 95% CI: 1.01-1.06), while LVESWS was not (HR: 1.00; 95% CI: 0.99-1.01).
Conclusions:
Among community-dwelling elderly individuals, greater LVEDWS is associated with a higher risk for incident HF.
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