Prognostic implications of left ventricular dyssynchrony for major adverse cardiovascular events in asymptomatic women and men: the Multi-Ethnic Study of Atherosclerosis

Ravi K Sharma, Gustavo Volpe, Boaz D Rosen, Bharat Ambale-Venkatesh, Sirisha Donekal, Veronica Fernandes, Colin O Wu, Jeffrey Carr, David A Bluemke, João A C Lima, Ravi K Sharma, Gustavo Volpe, Boaz D Rosen, Bharat Ambale-Venkatesh, Sirisha Donekal, Veronica Fernandes, Colin O Wu, Jeffrey Carr, David A Bluemke, João A C Lima

Abstract

Background: Left ventricular (LV) dyssynchrony is related to adverse outcomes in systolic heart failure, but its prognostic importance in asymptomatic population is not known. Our objective was to assess the prognostic implications of LV mechanical dyssynchrony in a large multiethnic population before the occurrence of global LV dysfunction.

Methods and results: A total of 1392 participants in the Multi-Ethnic Study of Atherosclerosis (MESA; mean age: 64.7 years; 46% were women) with cardiac magnetic resonance imaging at baseline were followed for a median duration of 8.3 years. Harmonic phase imaging analysis was used to derive systolic circumferential strain. Greater standard deviation of time to peak systolic strain (SD-TPS) indicates greater dyssynchrony. With SD-TPS as a continuous variable, Cox proportional hazards analysis was used to assess hazards ratio after adjusting for demographics, cardiovascular risk factors, LV mass-to-volume ratio, and ejection fraction. Using the 75th percentile of SD-TPS as a cutoff, Kaplan-Meier analysis was performed between 2 categorical groups for each gender. Higher values of dyssynchrony in women predicted major adverse cardiovascular events, defined as myocardial infarction, heart failure, stroke, and death (hazard ratio: 1.01 per 1-ms increment in SD-TPS, P=0.015), hard coronary events (hazard ratio: 1.05 per 1-ms increment in SD-TPS, P=0.026), and cerebrovascular events (hazard ratio: 1.03 per 1-ms increment in SD-TPS, P=0.013). In contrast, dyssynchrony in men was not predictive of events. Kaplan-Meier analyses in women revealed increased event occurrence in the higher dyssynchrony group, but this was not the case in men.

Conclusions: In an asymptomatic cohort, greater LV dyssynchrony determined by cardiac magnetic resonance imaging predicts adverse cardiovascular outcome in women but not in men.

Clinical trial registration url: https://ichgcp.net/clinical-trials-registry/NCT00005487" title="See in ClinicalTrials.gov">NCT00005487.

Keywords: cardiac magnetic resonance imaging; cardiovascular events; left ventricular dyssynchrony; prognosis.

© 2014 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Figures

Figure 1.
Figure 1.
Tagged cardiac magnetic resonance study with a sample representation of circumferential strain curve. The x‐axis in the strain curve represents time in milliseconds.
Figure 2.
Figure 2.
Kaplan–Meier curves for major adverse cardiac event occurrence in women and men. Group 1: ≤75th percentile of SD‐TPS; Group 2: >75th percentile of SD‐TPS. MACE indicates major adverse cardiovascular events; SD‐TPS, standard deviation of time to peak systolic circumferential strain.
Figure 3.
Figure 3.
Kaplan–Meier curves for secondary events outcome in women and men. Group 1: ≤75th percentile of standard deviation of time to peak systolic circumferential strain; Group 2: >75th percentile of standard deviation of time to peak systolic circumferential strain.
Figure 4.
Figure 4.
AV plot representing relationship of LV dyssynchrony (SD‐TPS) and concentric remodeling defined as LVMR. *Represents logarithmic transformation of SD‐TPS. The AV plot represents the graphical relationship between the “fitted values” of the study variables after multivariable linear regression. Adjustment parameters were age, sex, race, and heart rate. AV indicates added variable; coef, β‐coefficient; LV, left ventricle; LVMR, left ventricular mass to volume ratio; SD‐TPS, standard deviation of time to peak systolic circumferential strain; t, t statistics (derived as β‐coefficient/SE) of multivariable linear regression analysis.

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