Progression of Coronary Artery Calcium and Incident Heart Failure: The Multi‐Ethnic Study of Atherosclerosis

Abstract

BackgroundAlthough the association between coronary artery calcium (CAC) and future heart failure (HF) has been shown previously, the value of CAC progression in the prediction of HF has not been investigated. In this study, we investigated the association of CAC progression with subclinical left ventricular (LV) dysfunction and incident HF in the Multi‐Ethnic Study of Atherosclerosis.Methods and ResultsThe Multi‐Ethnic Study of Atherosclerosis is a population‐based study consisting of 6814 men and women aged 45 to 84, free of overt cardiovascular disease at enrollment, who were recruited from 4 ethnicities. We included 5644 Multi‐Ethnic Study of Atherosclerosis participants who had baseline and follow‐up cardiac computed tomography and were free of HF and coronary heart disease before the second cardiac computed tomography. Mean (±SD) age was 61.7±10.2 years and 47.2% were male. The Cox proportional hazard models and multivariable linear regression models were deployed to determine the association of CAC progression with incident HF and subclinical LV dysfunction, respectively. Over a median follow‐up of 9.6 (interquartile range: 8.8–10.6) years, 182 participants developed incident HF. CAC progression of 10 units per year was associated with 3% of increased risk of HF independent of overt coronary heart disease (P=0.008). In 2818 participants with available cardiac magnetic resonance images, CAC progression was associated with increased LV end diastolic volume (β=0.16; P=0.03) and LV end systolic volume (β=0.12; P=0.006) after excluding participants with any coronary heart disease.Conclusions CAC progression was associated with incident HF and modestly increased LV end diastolic volume and LV end systolic volume at follow‐up exam independent of overt coronary heart disease.

Independence of coronary artery disease to subclinical left ventricular dysfunction

“…Nonetheless, the results of this study suggest that subclinical atherosclerosis does not seem to be an important unifying feature in the development of subclinical LVD, so that when the two do co‐exist, the latter is less likely mediated through overall atherosclerotic burden than through shared risk factors like diabetes, renal impairment, and obesity. However, subclinical atherosclerosis may identify a cohort of those with SBHF likely to progress to Stage C heart failure 8 …”

“…Coronary artery calcification (CAC) provides direct evidence of coronary artery disease (CAD) in the asymptomatic stage. Although there is a strong association between CAC and incident HF, only partly mitigated after adjustment for cardiovascular risk factors, 7,8 it seems likely that this reflects the contribution of overt CAD to HF. Previous studies suggesting a link between CAC and LV dysfunction were in patients with very high burdens of CAC (≥400), 9 greater severity of LV dysfunction measured by ejection fraction, 10,11 or high baseline risk, such as those with suspected CAD or known diabetes 12,13 .…”

Influence of heart rate on coronary calcium scores: a multi-manufacturer phantom study

“…If risk-based treatment decision is uncertain after quantitative risk assessment, the 2013 guidelines recommend repeated CCS measurements. Also, CCS progression in repeated CCS measurements has recently been associated with heart failure [5].…”

Coronary Artery Calcium Is Associated with Left Ventricular Diastolic Function Independent of Myocardial Ischemia

“…[16][17][18][19] Moreover, several studies have recently shown an association between CAC and the development of heart failure. 3,4) Leening, et al reported that the extent of CAC had a clear association with the development of heart failure independent of overt coronary artery disease. 3) Bakhshi, et al showed that CAC progression assessed by serial CAC measurement was associated with incident heart failure independent of overt coronary artery disease.…”