Abstract 3150: Relationship of Fibrinogen with Regional Left Ventricular Dysfunction in Asymptomatic Individuals Without Clinical Cardiovascular Disease: The Multi-Ethnic Study of Atherosclerosis
Background: Fibrinogen (Fgn) is an acute phase reactant and an important determinant of blood viscosity and platelet aggregation. Elevated plasma Fgn has been demonstrated in prospective studies to be associated with increased risk of major adverse cardiovascular outcomes. However, the pathophysiology underlying this clinical observation has not been well elucidated. In this study, we evaluated the relationship between plasma Fgn and regional left ventricular (LV) function in an asymptomatic population without clinical cardiovascular disease.
Methods: Peak systolic midwall circumferential strain (Ecc) as a measure of regional myocardial function was determined at the base, mid-cavity and apex of the left ventricle in 1,099 individuals enrolled in the Multi-Ethnic Study of Atherosclerosis (MESA) using tagged magnetic resonance imaging. The independent relationship between Fgn and regional Ecc was examined using multivariable linear regression analysis.
Results: Among the study participants (age 66±10 years-old, 46.1% female), the mean and standard deviation (SD) of Fgn was 346±74 mg/dL. After adjustment for demographics (age, gender, ethnicity), traditional risk factors (blood pressure, diabetes, smoking, total cholesterol to HDL ratio), body mass index and serum creatinine, every 1 SD increment in Fgn was independently associated with an adverse reduction in absolute Ecc (impaired systolic function) in all 3 myocardial regions (0.30%, 95%CI 0.08%– 0.53%, P=0.007 at the base; 0.26%, 95%CI 0.10%– 0.42%, P=0.002 at mid-cavity; and 0.23%, 95%CI 0.05%– 0.41%, P=0.01 at the apex) and globally (0.21%, 95%CI 0.06%– 0.37%, P=0.007 for average LV Ecc). After further adjustment for subclinical atherosclerosis (coronary artery calcification), the independent relationships between Fgn and each of the regional and global Ecc measurements were maintained.
Conclusions: Among asymptomatic individuals without clinical cardiovascular disease, elevated Fgn is independently associated with impaired subclinical regional and global LV systolic function. These findings support possible roles of inflammation, procoagulation and hyperviscosity in the pathogenesis of incipient myocardial dysfunction.