Prognosis of Individuals with Asymptomatic Left Ventricular Systolic Dysfunction in the Multi-Ethnic Study of Atherosclerosis (MESA)
Background—Limited data exist on the prevalence, associations and prognosis of individuals with asymptomatic left ventricular systolic dysfunction (ALVSD), especially in populations without prior clinical cardiovascular disease (CVD).
Methods and Results—Kaplan-Meier and Cox proportional hazard analyses were used to assess the association between ALVSD, defined as left ventricular ejection fraction less than 50%, and adjudicated incident congestive heart failure (CHF), all-cause mortality, and CVD events. Out of 5004 participants, 112 participants had CHF, 321 had a CVD event, and 278 died after 9 years of follow-up. The overall prevalence of ALVSD was 1.7%, with a higher prevalence in African Americans (2.6%). ALVSD had worse cardiovascular risk profile and was also associated with increased risk in unadjusted and adjusted models for incident CHF [HR (95%): 12.0(7.04–20.3), p<0.0001 and 8.69(4.89–15.45), p<0.001 respectively], CVD [HR (95%):3.32(1.98–5.58), p<0.001 and 2.21(1.30–3.73), p=0.003 respectively] and all-cause mortality [HR(95%):3.47(2.03–5.94), p<0.0001 and 2.00(1.13–3.54), p=0.017 respectively]. A 10% decrement in LVEF at baseline was associated with increase in risk in unadjusted and adjusted models for clinical CHF [HR (95%CI): 2.17(1.82–2.63), p<0.0001 and 2.13(1.73–2.51), p<0.001 respectively] and all-cause mortality [HR (95%CI): 1.22(1.05–1.41), p=0.009 and 1.17(1.00–1.36), p=0.047 respectively]. Among the subset of participants with ALVSD, LVMI was particularly informative about risk for incident CHF (c-index = 0.74).
Conclusions—ALVSD is uncommon in individuals without prior clinical CVD, but is associated with high risk for CHF, CVD, and all-cause mortality. LVMI had good discrimination for incident CHF in MESA participants with ALVSD.
- cardiovascular events
- cardiovascular imaging
- heart failure
- asymptomatic left ventricular systolic dysfunction
- Received April 16, 2012.
- Accepted October 22, 2012.
- Copyright © 2012, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited