Left Ventricular Dilation and Incident Congestive Heart Failure in Asymptomatic Adults Without Cardiovascular Disease: Multi-Ethnic Study of Atherosclerosis (MESA)

JOURNAL OF CARDIAC FAILURE

卷:20

Article

Yeboah, Joseph^1,2,3  Bluemke, David A.⁴  Hundley, W. Gregory^1,2  Rodriguez, Carlos J.^1,2,3  Lima, Joao A. C.⁵  Herrington, David M.^1,2,3 

[1] Wake Forest Univ, Bowman Gray Sch Med, Dept Internal Med, Winston Salem, NC 27103 USA

[2] Wake Forest Univ, Bowman Gray Sch Med, Dept Cardiol, Winston Salem, NC USA

[3] Wake Forest Sch Med, Dept Epidemiol & Prevent, Winston Salem, NC 27157 USA

[4] NIH, Ctr Clin, Bethesda, MD 20892 USA

[5] Johns Hopkins Univ, Baltimore, MD USA

关键词: Left ventricular dilation;    left ventricular remodeling;    heart failure;    risk factors;    left ventricular ejection fraction;   

DOI  :  10.1016/j.cardfail.2014.09.002

来源: Elsevier

【 摘 要 】

Background: Limited data exist on the association between left ventricular (LV) dilation/remodeling and incident heart failure (I-IF), especially in adults without prior myocardial infarction (MI) and valvular heart disease. We assessed the association between LV dilation and remodeling and incident HF in a multiethnic cohort. Methods and Results: A total of 4,974 of 6,814 participants in the Multi-Ethnic Study of Atherosclerosis (MESA) had cardiac magnetic resonance imaging and complete data. Kaplan-Meier and Cox proportional hazard analyses were used to assess the association between LV end-diastolic diameter (LVEDD) and adjudicated HF. During the 12 years of follow-up (mean 9.4 y), 177 (3.6%) HF events occurred, 126(71.2%) in HF with reduced ejection fraction (EF) and 51(28.8%) in HF with preserved EF. LV dilation (LVEDD >52 mm or > 95th percentile) was associated with HF in univariate (hazard ratio [HR] 1.21, 95% confidence interval [CI] 1.08-1.46; P = .007) and multivariable Cox models (HR 1.28, 95% CI 1.09-1.57; P = .01) adjusting for traditional risk factors, medication use, LV EF, and interim MI. We found a significant multiplicative interaction between LVEDD and LV EF in our full multivariable models. Participants with dilated LV and preserved EF had increased risk [HR 2.22, 95% CI 1.46-3.37; P = .006) and those with dilated LV and reduced EF had worse prognosis (HR 7.35, 95% CI 2.36-22.85; P = .0006) compared with normal-size LV and preserved EF. A high proportion of participants with LV dilation had eccentric remodeling, a risk factor for HF. Concentric hypertrophy, also a risk factor for HF, was common in the normal-size LV group. Conclusions: LV dilation predicts incident HF independently from risk factors, LV EF, and interim MI.

【 授权许可】

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