Prognostic value of myocardial circumferential strain for incident heart failure and cardiovascular events in asymptomatic individuals: the Multi-Ethnic Study of Atherosclerosis

Choi, Eui‐Young; Rosen, Boaz D.; Fernandes, Verônica; Yan, Raymond T.; Yoneyama, Kihei; Donekal, Sirisha; Opdahl, Anders; Almeida, André Luiz Cerqueira de; Wu, Colin O.; Gomes, Antoinette S.; Bluemke, David A.; Lima, João A.C.

doi:10.1093/eurheartj/eht133

Cited by 130 publications

(113 citation statements)

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“…Previous studies of LV mechanical function and clinically important outcomes in the community have predominantly focused on a single primary measure of LV strain 7, 10, 11. Our study extends previous work by investigating LV strains in different planes and concurrently examining their association with distinct CVD outcomes and mortality.…”

Section: Discussionmentioning

confidence: 58%

“…Numerous studies have now demonstrated that speckle tracking analyses of LV strain (ie, myocardial tissue deformation) applied to routine echocardiography offer significant incremental prognostic information over EF in patients with known cardiovascular disease (CVD) 4, 5, 6, 7, 8, 9. However, there are few studies of LV strain and outcomes in community‐dwelling individuals free of overt CVD 10, 11. Furthermore, the degree to which distinct components of LV deformation in various planes provide specific prognostic information regarding risk of individual CVD outcomes (eg, coronary disease vs. HF) remains unclear 12, 13…”

Section: Introductionmentioning

confidence: 99%

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Distinct Aspects of Left Ventricular Mechanical Function Are Differentially Associated With Cardiovascular Outcomes and All‐Cause Mortality in the Community

Cheng

McCabe

Larson

et al. 2015

JAHA

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BackgroundThere are few data relating novel measures of left ventricular (LV) mechanical function to cardiovascular disease (CVD) outcomes in the community. Whether distinct components of LV mechanical function provide information regarding risk for different CVD outcomes is unclear.Methods and ResultsWe used speckle tracking echocardiography to quantify distinct components of LV mechanical function (measured as LV strain in multiple planes) in 2831 Framingham Offspring Study participants (mean age, 66 years; 57% women, 97% with LV fractional shortening >0.29). Participants were followed for 6.0±1.2 years for onset of 69 coronary heart disease (CHD), 71 heart failure (HF), and 199 mortality events. Adjusting for CVD risk factors, longitudinal LV strain appeared associated with incident CHD (hazards ratio [HR] per SD increment, 1.29; 95% confidence interval [CI], 1.00–1.67; P=0.05), whereas circumferential and radial strain were not (P>0.37 for both); however, the association of longitudinal strain with CHD was nonsignificant after Bonferroni correction. By contrast, circumferential strain was a significant predictor of incident HF (HR per SD increment, 1.79; 95% CI, 1.35–2.37; P<0.0001). Decrements in circumferential, radial, and longitudinal strain measures were related to all‐cause mortality (P<0.008 for all). Results remained similar in multivariable models adjusting additionally for the conventional echocardiographic measures of LV mass and fractional shortening.ConclusionsIn our large, community‐based sample, distinct components of LV mechanical function were associated with specific CVD outcomes. Additional studies are needed to replicate these findings and investigate the prognostic and therapeutic utility of these novel measures of LV mechanical function.

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Section: Discussionmentioning

confidence: 58%

Section: Introductionmentioning

confidence: 99%

Distinct Aspects of Left Ventricular Mechanical Function Are Differentially Associated With Cardiovascular Outcomes and All‐Cause Mortality in the Community

Cheng

McCabe

Larson

et al. 2015

JAHA

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“…In this study, the author did not measure GLS. 11 In the Framingham Heart Study (n=2831; mean age, 66 years), 12 LV GLS was borderline associated with incident coronary heart events (hazards ratio per SD increment 1.29; P=0.05), whereas circumferential strain was a significant predictor of incident HF (1.79; P<0.0001). Decrements in longitudinal and circumferential strain were significantly related to all-cause mortality in the Framingham study.…”

Section: Discussionmentioning

confidence: 99%

“…9,10 On the contrary, population-based studies are essential to determine the prognostic significance of subclinical LV systolic dysfunction. To date, 2 community-based studies reported on the incremental predictive value of magnetic resonance imaging 11 or echocardioraphically 12 derived LV circumferential strain for incident HF and coronary heart disease. To our knowledge,…”

Section: See Clinical Perspectivementioning

confidence: 99%

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Additive Prognostic Value of Left Ventricular Systolic Dysfunction in a Population-Based Cohort

Kuznetsova

Cauwenberghs

Knez

et al. 2016

Circ: Cardiovascular Imaging

105

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Background-Techniques of 2-dimensional speckle tracking enable the measurement of myocardial deformation (strain) during systole. Recent clinical studies explored the prognostic role of left ventricular global longitudinal strain (GLS). However, there are few data on the association between cardiovascular outcome and GLS in the community. Therefore, we hypothesized that GLS contains additive prognostic information over and beyond traditional cardiovascular risk factors in a large, population-based cohort. Methods and Results-We measured GLS by 2-dimensional speckle tracking in the apical 4-chamber view in 791 participants (mean age 50.9 years). We calculated multivariable adjusted hazard ratios for midwall, endocardial, and epicardial GLS, while accounting for family cluster and cardiovascular risk factors. Median follow-up was 7.9 years (5th to 95th percentile, 3.7-9.6). In continuous analysis, with adjustments applied for covariables, midwall, endocardial, and epicardial GLS were significant predictors of fatal and nonfatal cardiovascular (n=96; P<0.0001) and cardiac events (n=68; P≤0.001). In the sex-specific low quartile of midwall GLS (<18.8% in women and <17.4% in men), the risk was significantly higher than the average population risk for cardiovascular (128%, P<0.0001) and cardiac (94%, P=0.0007) events. We also noticed that the risk for cardiovascular events increased with increasing number of left ventricular abnormalities, such as low GLS, diastolic dysfunction, and hypertrophy (log-rank P<0.0001). Conclusions-Low GLS measured by 2-dimensional speckle tracking predicts future cardiovascular events independent of conventional risk factors. Left ventricular midwall strain represents a simple echocardiographic measure, which might be used for assessing cardiovascular risk in a population-based cohort. Methods Study ParticipantsThe Ethics Committee of the University of Leuven approved the Flemish Study on Environment, Genes and Health Outcomes (FLEMENGHO), a large family-based population resource on the genetic epidemiology of cardiovascular phenotypes. 13,14 From August 1985 to December 2005, we identified a random population sample stratified by sex and age from a geographically defined area in northern Belgium as described in the Data Supplement.13,14 From 2005 to 2009, we invited 1031 former participants for a technical examination at our field center, including echocardiography. We obtained informed written consent from 828 subjects (participation rate, 80%). To study the incidence of mortality and morbidity in relation to baseline LV systolic dysfunction, we collected outcome data on average 7.9 years after their first echocardiographic examination. For the current analysis, we further excluded 37 subjects because of atrial fibrillation (n=8), the presence of an artificial pacemaker (n=3), or because of GLS (n=22) or diastolic function (n=4) could not be reliably determined. Thus, the outcome cohort included 791 participants. EchocardiographyEchocardiographic methods are detailed in Methods sectio...

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Association of the V122I Transthyretin Amyloidosis Genetic Variant With Cardiac Structure and Function in Middle-aged Black Adults

et al. 2021

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The variant V122I is commonly enriched in the transthyretin (TTR) gene in individuals of African ancestry and associated with greater risk of heart failure (HF) in older adulthood, after age 65 years. Prevention of HF may be most effective earlier in life, but whether screening with echocardiography can identify subclinical cardiac abnormalities during middle age to risk-stratify individuals appears to be unknown.OBJECTIVE To examine the association between the V122I TTR variant and cardiac structure and function during middle age in those without prevalent HF. DESIGN, SETTING, AND PARTICIPANTSThis serial cross-sectional study of 875 Black participants in the Coronary Artery Risk Development in Young Adults (CARDIA) cohort was conducted at 4 urban sites across the US. Recruiting was completed in 1985-1986, and follow-up examinations occurred 25 and 30 years later. A subset of Black adults from the CARDIA cohort who underwent TTR genotyping was included. Data analysis was completed from January 2020 to October 2020.EXPOSURES The V122I TTR genotype.MAIN OUTCOMES AND MEASURES Echocardiographic left ventricular (LV) circumferential and longitudinal systolic strain and LV structure, measured at years 25 and 30 of follow-up. The analyses were adjusted for age, sex, echocardiography quality, genetic ancestry, and field center.RESULTS Among the 875 Black adults (mean [SD] age, 49.4 [3.8] years at year 25; 543 women [62.1%]), there were 31 individuals who were heterozygous and 1 who was homozygous for the V122I TTR variant. Of the adults who had an echocardiogram at year 25, rates of hypertension (312 [46%]), diabetes (102 [15%]), and current smoking (128 [19%]) were not significantly different between those who did and did not carry V122I TTR. At year 25, there was no difference in LV circumferential strain, longitudinal strain, or LV structure between those who did vs did not carry V122I TTR. At year 30, those who carried V122I TTR had significantly lower absolute LV circumferential strain (mean [SD], 12.4 [4.2] percentage units) compared with those who did not carry the variant (mean [SD], 14.5 [3.7] percentage units). Those who carried V122I TTR also had significantly higher LV mass index values (mean [SD], 97.5 [34.1] g/m 2 ) compared with those who did not (mean [SD], 83.7 [22.6] g/m 2 ) at year 30. CONCLUSIONS AND RELEVANCECarrier status for the V122I TTR variant is associated with subclinical cardiac abnormalities in middle age (worse LV systolic function and higher LV mass) that have been associated with increased risk of incident HF. Midlife screening of individuals who carry V122I TTR with echocardiography may prognosticate risk of symptomatic HF and inform prevention strategies.

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Prognostic value of myocardial circumferential strain for incident heart failure and cardiovascular events in asymptomatic individuals: the Multi-Ethnic Study of Atherosclerosis

Abstract: http://www.clinicaltrials.gov. Unique identifier: NCT00005487.

Cited by 130 publications

References 26 publications

Distinct Aspects of Left Ventricular Mechanical Function Are Differentially Associated With Cardiovascular Outcomes and All‐Cause Mortality in the Community

Distinct Aspects of Left Ventricular Mechanical Function Are Differentially Associated With Cardiovascular Outcomes and All‐Cause Mortality in the Community

Additive Prognostic Value of Left Ventricular Systolic Dysfunction in a Population-Based Cohort

Association of the V122I Transthyretin Amyloidosis Genetic Variant With Cardiac Structure and Function in Middle-aged Black Adults

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