Association of Left Ventricular Systolic Function With Incident Heart Failure in Late Life

Abstract

IMPORTANCE Limited data exist regarding the association of subtle subclinical systolic dysfunction and incident heart failure (HF) in late life.OBJECTIVE To assess the independent associations of subclinical impairments in systolic performance with incident HF in late life. DESIGN, SETTING, AND PARTICIPANTSThis study was a time-to-event analysis of participants without heart failure in the Atherosclerosis Risk in Communities (ARIC) study, a prospective, community-based cohort study, who underwent protocol echocardiography at the fifth study visit (January 1, 2011, to December 31, 2013. Findings were validated independently in participants in the Copenhagen City Heart Study (CCHS). Data analysis was performed from June 1, 2018, to February 28, 2020.EXPOSURES Left ventricular ejection fraction (LVEF), longitudinal strain (LS), and circumferential strain (CS) measured by 2-dimensional and strain echocardiography.MAIN OUTCOMES AND MEASURES Main outcomes were incident adjudicated HF and HF with preserved and reduced LVEF at a median follow-up of 5.5 years (interquartile range, 5.0-5.8 years). Cox proportional hazards regression models adjusted for demographics, hypertension, diabetes, obesity, smoking, coronary disease, estimated glomerular filtration rate, LV mass index, e′, E/e′, and left atrial volume index. Lower 10th percentile limits were determined in 374 participants free of cardiovascular disease or risk factors. RESULTS Among 4960 ARIC participants (mean [SD] age, 75 [5] years; 2933 [59.0%] female; 965 [19%] Black), LVEF was less than 50% in only 76 (1.5%). In the 3552 participants with complete assessment of LVEF, LS, and CS, 983 (27.7%) had 1 or more of the following findings: LVEF less than 60%, LS less than 16.0%, or CS less than 23.7%. Modeled continuously or dichotomized, worse LVEF, LS, and CS were each independently associated with incident HF. The adjusted hazard ratio (HR) per SD decrease in LVEF was 1.41 (95% CI, 1.29-1.55); the HR for LVEF less than 60% was 2.59 (95% CI, 1.99-3.37). Similar findings were observed for continuous LS (HR, 1.37; 95% CI, 1.22-1.53) and dichotomized LS (HR, 1.93; 95% CI, 1.46-2.55) and for continuous CS (HR, 1.39; 95% CI, 1.22-1.57) and dichotomized CS (HR, 2.30; 95% CI, 1.64-3.22). Although the magnitude of risk for incident HF or death associated with impaired LVEF was greater using guideline (HR, 2.99; 95% CI, 2.19-4.09) compared with ARIC-based limits (HR, 1.88; 95% CI, 1.58-2.25), the number of participants classified as impaired was less (104 [2.1%] based on guideline thresholds compared with 692 [13.9%] based on LVEF <60%). The population-attributable risk associated with LVEF less than 60% was 11% compared with 5% using guideline-based limits, a finding replicated in 908 participants in the CCHS.CONCLUSIONS AND RELEVANCE These findings suggest that relatively subtle impairments of systolic function (detected based on LVEF or strain) are independently associated with incident HF and HF with reduced LVEF in late life. Current recommended assessments of LV functio...

Potential role of conventional and speckle-tracking echocardiography in the screening of structural and functional cardiac abnormalities in elderly individuals: Baseline echocardiographic findings from the LOOP study

“…LV systolic dysfunction by LVEF was more frequent as compared to other population-based studies, which have generally observed a prevalence of 1–2% [ 29 ]. However, estimates from the Rotterdam Study revealed a higher prevalence of systolic dysfunction with increasing age, afflicting around 5–10% of elderly aged above 75 years of age [ 30 ], and this may even be an underestimate as they defined systolic dysfunction by fractional shortening which is less sensitive than LVEF for detecting systolic dysfunction.…”

“…It is worth noting that abnormal GLS was not an infrequent finding when LVEF was preserved, whereas abnormal LVEF was seldomly observed when GLS was normal, supporting GLS’ application to detect subclinical LV systolic dysfunction. While GLS has shown to be a powerful predictor of outcome in patients with overt heart disease [ 32 ], it has also shown promise in at-risk patients [ 29 , 33 ]. Shah and Solomon outlined the evolution of systolic function from a preclinical stage–in the presence of risk factors–to the development of overt heart disease [ 34 ].…”

Layer‐specific global longitudinal strain and the risk of heart failure and cardiovascular mortality in the general population: the Copenhagen City Heart Study

“…None of the aforementioned studies investigating the prognostic value of layer‐specific GLS assessed whether sex modified the association. However, a study by Reimer Jensen et al 22 . investigated the prognostic value of GLS WW in regard to the development of HF in 4960 participants of the Atherosclerosis Risk in Communities (ARIC) study.…”

Depressive Symptoms, Cardiac Structure and Function, and Risk of Incident Heart Failure With Preserved Ejection Fraction and Heart Failure With Reduced Ejection Fraction in Late Life

“…Analyses comparing clinical characteristics across CES‐D score categories were adjusted for demographics, whereas comparisons of echocardiographic features were adjusted for demographics (age, sex, race, and field center), socioeconomic indicators (education and income), health behaviors (smoking, drinking, and physical activity), and prevalent chronic conditions and cardiovascular risk factors (hypertension, diabetes mellitus, prevalent atrial fibrillation, prevalent coronary heart disease, prevalent stroke, history of myocardial infarction, BMI, and eGFR). Multivariable logistic regressions were used to assess the association of CES‐D score categories with abnormal echocardiographic measures, defined using cutoffs based on normative values from the ARIC study 30 , 31 , 32 and American Society of Echocardiography guidelines. 20 Model covariates were selected on the basis of a priori knowledge of demographic covariates, socioeconomic indicators, health behaviors, and prevalent chronic conditions and cardiovascular risk factors associated with depression and heart failure, as also applied in several similar studies.…”