Prognosis of individuals with asymptomatic left ventricular systolic dysfunction in the Multi-Ethnic Study of Atherosclerosis (MESA)

Joseph Yeboah, Carlos J. Rodriguez, Brandon Stacey, Joao A. Lima, Songtao Liu, J. Jeffrey Carr, W. Gregory Hundley, David M. Herrington

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Background-Limited data exist on the prevalence, associations, and prognosis of individuals with asymptomatic left ventricular systolic dysfunction (ALVSD), especially in populations without previous clinical cardiovascular disease (CVD). Methods and Results-Kaplan-Meier and Cox proportional hazard analyses were used to assess the association between ALVSD, defined as left ventricular ejection fraction <50%, and adjudicated incident congestive heart failure (CHF), all-cause mortality, and CVD events. Of 5004 participants, 112 participants had CHF, 321 had a CVD event, and 278 died after 9 years of follow-up. The overall prevalence of ALVSD was 1.7%, with a higher prevalence in blacks (2.6%). ALVSD had a worse cardiovascular risk profile and was also associated with increased risk in unadjusted and adjusted models for incident CHF (HR [hazard ratio] [95% CI {confidence interval}]: 12.0 [7.04-20.3], P<0.0001 and 8.69 [4.89-15.45], P<0.001 respectively), CVD (HR [95% CI]: 3.32 [1.98-5.58], P<0.001 and 2.21 [1.30-3.73], P=0.003 respectively), and all-cause mortality (HR [95% CI]: 3.47 [2.03-5.94], P<0.0001 and 2.00 [1.13-3.54], P=0.017, respectively). A 10% decrement in left ventricular ejection fraction at baseline was associated with an increase in risk in unadjusted and adjusted models for clinical CHF (HR [95% CI]: 2.17 [1.82-2.63], P<0.0001 and 2.13 [1.73-2.51], P<0.001, respectively) and all-cause mortality (HR [95% CI]: 1.22 [1.05-1.41], P=0.009 and 1.17 [1.00-1.36], P=0.047, respectively). Among the subset of participants with ALVSD, the left ventricular mass index was particularly informative about risk for incident CHF (c-index=0.74). Conclusions-ALVSD is uncommon in individuals without previous clinical CVD, but it is associated with high risk for CHF, CVD, and all-cause mortality. The left ventricular mass index had good discrimination for incident CHF in Multi-Ethnic Study of Atherosclerosis (MESA) participants with ALVSD.

Original languageEnglish (US)
Pages (from-to)2713-2719
Number of pages7
JournalCirculation
Volume126
Issue number23
DOIs
StatePublished - Dec 4 2012
Externally publishedYes

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Left Ventricular Dysfunction
Atherosclerosis
Heart Failure
Cardiovascular Diseases
Confidence Intervals
Mortality
Stroke Volume
Population

Keywords

  • Asymptomatic left ventricular systolic dysfunction
  • Cardiovascular events
  • Cardiovascular imaging
  • Death
  • Heart failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Prognosis of individuals with asymptomatic left ventricular systolic dysfunction in the Multi-Ethnic Study of Atherosclerosis (MESA). / Yeboah, Joseph; Rodriguez, Carlos J.; Stacey, Brandon; Lima, Joao A.; Liu, Songtao; Carr, J. Jeffrey; Hundley, W. Gregory; Herrington, David M.

In: Circulation, Vol. 126, No. 23, 04.12.2012, p. 2713-2719.

Research output: Contribution to journalArticle

Yeboah, Joseph ; Rodriguez, Carlos J. ; Stacey, Brandon ; Lima, Joao A. ; Liu, Songtao ; Carr, J. Jeffrey ; Hundley, W. Gregory ; Herrington, David M. / Prognosis of individuals with asymptomatic left ventricular systolic dysfunction in the Multi-Ethnic Study of Atherosclerosis (MESA). In: Circulation. 2012 ; Vol. 126, No. 23. pp. 2713-2719.
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title = "Prognosis of individuals with asymptomatic left ventricular systolic dysfunction in the Multi-Ethnic Study of Atherosclerosis (MESA)",
abstract = "Background-Limited data exist on the prevalence, associations, and prognosis of individuals with asymptomatic left ventricular systolic dysfunction (ALVSD), especially in populations without previous clinical cardiovascular disease (CVD). Methods and Results-Kaplan-Meier and Cox proportional hazard analyses were used to assess the association between ALVSD, defined as left ventricular ejection fraction <50{\%}, and adjudicated incident congestive heart failure (CHF), all-cause mortality, and CVD events. Of 5004 participants, 112 participants had CHF, 321 had a CVD event, and 278 died after 9 years of follow-up. The overall prevalence of ALVSD was 1.7{\%}, with a higher prevalence in blacks (2.6{\%}). ALVSD had a worse cardiovascular risk profile and was also associated with increased risk in unadjusted and adjusted models for incident CHF (HR [hazard ratio] [95{\%} CI {confidence interval}]: 12.0 [7.04-20.3], P<0.0001 and 8.69 [4.89-15.45], P<0.001 respectively), CVD (HR [95{\%} CI]: 3.32 [1.98-5.58], P<0.001 and 2.21 [1.30-3.73], P=0.003 respectively), and all-cause mortality (HR [95{\%} CI]: 3.47 [2.03-5.94], P<0.0001 and 2.00 [1.13-3.54], P=0.017, respectively). A 10{\%} decrement in left ventricular ejection fraction at baseline was associated with an increase in risk in unadjusted and adjusted models for clinical CHF (HR [95{\%} CI]: 2.17 [1.82-2.63], P<0.0001 and 2.13 [1.73-2.51], P<0.001, respectively) and all-cause mortality (HR [95{\%} CI]: 1.22 [1.05-1.41], P=0.009 and 1.17 [1.00-1.36], P=0.047, respectively). Among the subset of participants with ALVSD, the left ventricular mass index was particularly informative about risk for incident CHF (c-index=0.74). Conclusions-ALVSD is uncommon in individuals without previous clinical CVD, but it is associated with high risk for CHF, CVD, and all-cause mortality. The left ventricular mass index had good discrimination for incident CHF in Multi-Ethnic Study of Atherosclerosis (MESA) participants with ALVSD.",
keywords = "Asymptomatic left ventricular systolic dysfunction, Cardiovascular events, Cardiovascular imaging, Death, Heart failure",
author = "Joseph Yeboah and Rodriguez, {Carlos J.} and Brandon Stacey and Lima, {Joao A.} and Songtao Liu and Carr, {J. Jeffrey} and Hundley, {W. Gregory} and Herrington, {David M.}",
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T1 - Prognosis of individuals with asymptomatic left ventricular systolic dysfunction in the Multi-Ethnic Study of Atherosclerosis (MESA)

AU - Yeboah, Joseph

AU - Rodriguez, Carlos J.

AU - Stacey, Brandon

AU - Lima, Joao A.

AU - Liu, Songtao

AU - Carr, J. Jeffrey

AU - Hundley, W. Gregory

AU - Herrington, David M.

PY - 2012/12/4

Y1 - 2012/12/4

N2 - Background-Limited data exist on the prevalence, associations, and prognosis of individuals with asymptomatic left ventricular systolic dysfunction (ALVSD), especially in populations without previous clinical cardiovascular disease (CVD). Methods and Results-Kaplan-Meier and Cox proportional hazard analyses were used to assess the association between ALVSD, defined as left ventricular ejection fraction <50%, and adjudicated incident congestive heart failure (CHF), all-cause mortality, and CVD events. Of 5004 participants, 112 participants had CHF, 321 had a CVD event, and 278 died after 9 years of follow-up. The overall prevalence of ALVSD was 1.7%, with a higher prevalence in blacks (2.6%). ALVSD had a worse cardiovascular risk profile and was also associated with increased risk in unadjusted and adjusted models for incident CHF (HR [hazard ratio] [95% CI {confidence interval}]: 12.0 [7.04-20.3], P<0.0001 and 8.69 [4.89-15.45], P<0.001 respectively), CVD (HR [95% CI]: 3.32 [1.98-5.58], P<0.001 and 2.21 [1.30-3.73], P=0.003 respectively), and all-cause mortality (HR [95% CI]: 3.47 [2.03-5.94], P<0.0001 and 2.00 [1.13-3.54], P=0.017, respectively). A 10% decrement in left ventricular ejection fraction at baseline was associated with an increase in risk in unadjusted and adjusted models for clinical CHF (HR [95% CI]: 2.17 [1.82-2.63], P<0.0001 and 2.13 [1.73-2.51], P<0.001, respectively) and all-cause mortality (HR [95% CI]: 1.22 [1.05-1.41], P=0.009 and 1.17 [1.00-1.36], P=0.047, respectively). Among the subset of participants with ALVSD, the left ventricular mass index was particularly informative about risk for incident CHF (c-index=0.74). Conclusions-ALVSD is uncommon in individuals without previous clinical CVD, but it is associated with high risk for CHF, CVD, and all-cause mortality. The left ventricular mass index had good discrimination for incident CHF in Multi-Ethnic Study of Atherosclerosis (MESA) participants with ALVSD.

AB - Background-Limited data exist on the prevalence, associations, and prognosis of individuals with asymptomatic left ventricular systolic dysfunction (ALVSD), especially in populations without previous clinical cardiovascular disease (CVD). Methods and Results-Kaplan-Meier and Cox proportional hazard analyses were used to assess the association between ALVSD, defined as left ventricular ejection fraction <50%, and adjudicated incident congestive heart failure (CHF), all-cause mortality, and CVD events. Of 5004 participants, 112 participants had CHF, 321 had a CVD event, and 278 died after 9 years of follow-up. The overall prevalence of ALVSD was 1.7%, with a higher prevalence in blacks (2.6%). ALVSD had a worse cardiovascular risk profile and was also associated with increased risk in unadjusted and adjusted models for incident CHF (HR [hazard ratio] [95% CI {confidence interval}]: 12.0 [7.04-20.3], P<0.0001 and 8.69 [4.89-15.45], P<0.001 respectively), CVD (HR [95% CI]: 3.32 [1.98-5.58], P<0.001 and 2.21 [1.30-3.73], P=0.003 respectively), and all-cause mortality (HR [95% CI]: 3.47 [2.03-5.94], P<0.0001 and 2.00 [1.13-3.54], P=0.017, respectively). A 10% decrement in left ventricular ejection fraction at baseline was associated with an increase in risk in unadjusted and adjusted models for clinical CHF (HR [95% CI]: 2.17 [1.82-2.63], P<0.0001 and 2.13 [1.73-2.51], P<0.001, respectively) and all-cause mortality (HR [95% CI]: 1.22 [1.05-1.41], P=0.009 and 1.17 [1.00-1.36], P=0.047, respectively). Among the subset of participants with ALVSD, the left ventricular mass index was particularly informative about risk for incident CHF (c-index=0.74). Conclusions-ALVSD is uncommon in individuals without previous clinical CVD, but it is associated with high risk for CHF, CVD, and all-cause mortality. The left ventricular mass index had good discrimination for incident CHF in Multi-Ethnic Study of Atherosclerosis (MESA) participants with ALVSD.

KW - Asymptomatic left ventricular systolic dysfunction

KW - Cardiovascular events

KW - Cardiovascular imaging

KW - Death

KW - Heart failure

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