Sex-specific Associations between Left Ventricular Remodeling at MRI and Long-term Cardiovascular Risk

Area of Science:

• Cardiology
• Cardiovascular Imaging
• Preventive Cardiology

Background:

• Left ventricular mass (LVM) is a known cardiovascular risk marker.
• Long-term follow-up data in low-to-intermediate risk populations are limited.
• Cardiac MRI can assess LVM and cardiac remodeling patterns.

Purpose of the Study:

• To investigate the sex-specific association between LVM and cardiovascular outcomes.
• To evaluate LVM measured by cardiac MRI in individuals with <20% 10-year cardiovascular disease (CVD) risk.
• To identify differential predictors of CVD events based on cardiac structure.

Main Methods:

• Prospective study of 1528 volunteers >40 years old with <20% 10-year CVD risk and elevated B-type natriuretic peptide.
• Cardiac MRI was used to measure LVM indexed to body surface area and LVM-to-volume ratio.
• National electronic health records were used for median 10-year follow-up of cardiovascular events; Cox proportional hazard models were applied.

Main Results:

• In women, the LVM-to-volume ratio predicted cardiovascular events (HR, 2.3; 95% CI: 1.1, 4.9), but LVM did not.
• In men, increased LVM predicted cardiovascular events (HR, 3.2; 95% CI: 1.5, 7.0), but the LVM-to-volume ratio did not.
• LVM associations varied by sex: in women, LVM correlated with age, blood pressure, smoking, and cholesterol; in men, with age and blood pressure.

Conclusions:

• Sex-specific cardiac remodeling patterns predict cardiovascular events in low-to-intermediate risk individuals without established CVD.
• Increased LVM is a significant predictor of cardiovascular events in men.
• The LVM-to-volume ratio is a significant predictor of cardiovascular events in women.