Abstract 16826: Older Adults With Unrecognized Myocardial Infarction Have Increased Risk of Heart Failure
Background: Heart failure (HF) is an important cause of morbidity and mortality in older populations. In this study we characterized the risk of HF in relation to unrecognized myocardial infarction (UMI) among those without prevalent cardiovascular disease (CVD) in an elderly cohort.
Methods: The study subjects were the participants of the Iceland_MI substudy of the Age, Gene/Environment Susceptibility-Reykjavik study, a population based prospective study of older adults. We excluded subjects with prevalent CVD defined as a history of recognized MI, acute coronary syndrome, HF, cardiac arrest, ventricular arrhythmia and stroke. Left ventricular ejection fraction (LVEF) was assessed using cine MRI and UMI was determined by late gadolinium enhancement imaging. Incident HF was adjudicated based on medical records.
Results: Of the 701 subjects analyzed, the mean age was 77±5 years, 57% were female and 34% diabetic. The prevalence of UMI was inversely related to the LVEF, 50%, 24% and 10% for LVEF≤45% (n=26) LVEF 46-54% (N=78) and LVEF≥55% (N=580) (p<0.001), respectively. UMI prevalence did not differ among LVEF subgroups with and without diabetes (P=0.188). Coronary calcium score was much higher in subjects with UMI compared to those without, 873±866 (HU) vs 457±707 (HU) (p<0.001). The difference was consistent among LVEF subgroups. During mean follow up duration of 6.1±1.3 years there were 87 cases of HF. The incidence of HF was much higher in subjects with abnormal LVEF when UMI was present. In patients with UMI, the incidence of HF was 39% in subjects with LVEF≤45% and 32% in subjects with LVEF 46-54%. In subjects without UMI, the incidence of HF was lower (17% and 12%) for corresponding degrees of LVEF abnormality (p=0.009). There was a significant interaction of LVEF and UMI for incident HF (p=0.038). In multivariate logistic regression analysis age, diabetes, UMI and the interaction of LVEF and UMI predicted HF.
Conclusions: Older adults without known cardiovascular disease can have UMI even with normal LVEF but prevalence increases with lower LVEF. UMI, age, diabetes and the interaction of LVEF and UMI were important predictors of incident HF.
Author Disclosures: J.J. Cao: None. E.B. Schelbert: None. T. Aspelund: None. P. Kellman: None. G. Thorgeirsson: None. S. Sigurdsson: None. G. Eiriksdottir: None. L.J. Launer: None. T.B. Harris: None. V. Gudnason: None. A.E. Arai: None.
- © 2014 by American Heart Association, Inc.