Abstract 368: Echocardiographic Predictors of Incident Heart Failure in Young Black Adults: The CARDIA Study
Background: Black men and women are at greater risk of heart failure (HF) in young and middle age compared with whites. The echocardiographic (echo) antecedents of HF in young adulthood are not well understood.
Methods: The Coronary Artery Risk Development in Young Adults (CARDIA) study enrolled asymptomatic black and white subjects ages 18 –30 years at baseline and followed them over 20 years for incident HF. We examined echo parameters present at the year 5 examination that predicted subsequent HF hospitalization or death using Cox proportional hazards models. Because HF occurred almost exclusively in blacks, the analysis was restricted to black men and women.
Results: Of 1957 subjects with complete baseline echo data, 19 developed subsequent HF. Echo parameters when participants were 23–35 years of age varied by their subsequent HF status: those who subsequently developed HF had lower LV ejection fraction (EF) (50±14 vs 58±8%, p<0.001), higher LV mass index (47±20 vs 37±10 g/m2.7, p<0.001), lower E/A velocity ratio (1.6±0.5 vs 1.8±0.5, p=0.09), and higher left atrial dimension index (LAD) (2.1±0.5 vs 1.9±0.2 cm/m2, p<0.001). In bivariate analyses, each of these echo parameters in young adulthood predicted incident HF on average 10 years later (Table 1⇓). After adjustment for age, sex, diastolic blood pressure, body-mass index, diabetes, and echo parameters, EF and LAD remained independent predictors of HF. Each standard deviation (SD) decrease in EF doubled the risk of HF, and every SD increase in LAD led to a 60% increased risk of subsequent HF.
Conclusions: Echo antecedents of incident HF were already apparent in the CARDIA cohort at the age of 23–35 years, a decade before HF outcomes occurred. In addition to lower LVEF, greater LAD predicted incident HF independent of other clinical and echo factors, consistent with the possibility of underlying cardiomyopathy.