Associations of Left Atrial Dimension and Ventricular Mass With Long-Term Health Outcomes: Framingham Heart Study

Higher left atrial end-systolic dimension (LASD) and left ventricular mass (LVM) are associated with higher risk of cardiovascular disease (CVD) over short-term follow-up (<10 years). However, data on long-term associations are limited.

The objective of the study was to evaluate associations of echocardiography-derived LASD and LVM with risk of mortality, CVD, dementia, hypertension, diabetes, and chronic kidney disease over long-term follow-up among Framingham participants.

Clinical covariates and up to 3 serial echocardiographic observations were collected from 1991 to 2008 (median follow-up 17 years; range: 0-29 years). Analyses of incident outcomes excluded those with prevalent disease or missing outcomes.

Among 8,192 participants (mean age 48 ± 13 years, 54.3% women), we observed 1,245 deaths, 946 CVD, 290 dementia, 1,565 hypertension, 463 diabetes, and 583 chronic kidney disease events. Higher LASD and LVM were associated with higher risk of all outcomes (modeled separately; all P < 0.05), except for coronary heart disease. Participants with higher LASD and LVM (modeled jointly) had higher death and CVD risk, including hard and atherosclerotic CVD (HR per-SD ranged from 1.18-1.28; all P < 0.001). Higher LASD (HR: 1.39; 95% CI: 1.06-1.84) and LVM (HR: 1.37, 95% CI: 1.08-1.74) were associated with higher risk of HF with preserved ejection fraction, whereas higher LVM was associated with higher risk of HF with reduced ejection fraction (HR: 2.13; 95% CI: 1.63-2.78), per-SD increase.

In our large community-based sample, we observed associations of LASD and LVM with risk of multiple health outcomes over long-term follow-up. These findings underscore the importance of maintaining optimal LASD and LVM values over the life course.