Author + information
- Received July 2, 2010
- Revision received October 5, 2010
- Accepted October 19, 2010
- Published online April 26, 2011.
- Raymond T. Yan, MD, MASc⁎,
- David Bluemke, MD, PhD†,
- Antoinette Gomes, MD‡,
- Gregory Burke, MD§,
- Steve Shea, MD, MS∥,
- Kiang Liu, PhD¶,
- Hossein Bahrami, MD, MPH⁎,
- Shantanu Sinha, PhD#,
- Colin Wu, PhD⁎⁎,
- Veronica Fernandes, MD, PhD⁎,
- Robyn McClelland, PhD†† and
- João A.C. Lima, MD⁎,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. João A. C. Lima, Division of Cardiology, Blalock 524, Johns Hopkins Hospital, 600 N. Wolfe Street, Baltimore, Maryland 21287-0409
Objectives We sought to examine the prognostic value of subclinical left ventricular (LV) regional myocardial dysfunction (RMD) measured by magnetic resonance imaging (MRI) among asymptomatic individuals.
Background LV RMD, defined as segmental impairment in systolic wall thickening, predicts adverse events in patients with established cardiovascular disease. MRI is highly accurate for detecting subtle RMD, of which the prognostic significance in a large multiethnic asymptomatic population is not known.
Methods We used MRI to evaluate baseline regional LV myocardial function and prospectively followed a multiethnic (African American, Caucasian, Chinese, and Hispanic) population-based sample of 4,510 men and women without cardiovascular disease for a mean of 4.6 years. Regional myocardial dysfunction was defined as the presence of impaired systolic wall thickening (<10th percentile of segment-specific population distribution) in ≥2 contiguous LV segments within any given coronary artery territory.
Results Baseline prevalence of RMD was 25.6%. Heart failure developed in 34 (1.0%) and 30 (2.6%) participants without and with RMD, respectively (p < 0.001). After adjustment for demographics and traditional risk factors, RMD remained independently associated with incident heart failure (hazard ratio [HR]: 2.62; 95% confidence interval [CI]: 1.56 to 4.39; p < 0.001). The relationship persisted after further adjustment for biomarkers of reported association with cardiovascular disease and indexes of global LV systolic dysfunction and hypertrophy (HR: 1.80; 95% CI: 1.02 to 3.20; p = 0.044). Similarly, RMD independently conferred an increased risk for hard coronary events (myocardial infarction or death from coronary heart disease; HR: 1.75; 95% CI: 1.06 to 2.89; p = 0.029), the composite of hard coronary events and stroke (HR: 1.72; 95% CI: 1.16 to 2.56; p = 0.005), and all atherosclerotic cardiovascular events (HR: 1.50; 95% CI: 1.09 to 2.07; p = 0.012).
Conclusions Among an asymptomatic multiethnic American cohort, RMD is an independent predictor beyond traditional risk factors and global LV assessment for incident heart failure and atherosclerotic cardiovascular events. The clinical utility of early recognition of this subclinical phenotype deserves further investigation. (Multi-Ethnic Study of Atherosclerosis [MESA]; NCT00005487)
This study was supported in part by National, Heart, Lung and Blood Institute grants RO1-HL66075-01 and MESA study contracts NO1-HC-95159 through NO1-HC-95168. Dr. Yan was supported by Fellowship Awards from the Canadian Institutes of Health Research and the Detweiler Travelling Fellowship Award from the Royal College of Physicians and Surgeons of Canada. The authors have reported that they have no relationships to disclose. Kim Allan Williams, Sr, MD, served as Guest Editor for this paper.
- Received July 2, 2010.
- Revision received October 5, 2010.
- Accepted October 19, 2010.
- American College of Cardiology Foundation