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Left ventricular area on non-contrast cardiac computed tomography as a predictor of incident heart failure - The Multi-Ethnic Study of Atherosclerosis.

ABSTRACT: BACKGROUND:The use of non-contrast cardiac computed tomography measurements to predict heart failure (HF) has not been studied. In the present study we evaluated the prognostic value of left ventricular area adjusted for the body surface area (LVA-BSA) measured by non-contrast cardiac CT to predict incident HF and cardiovascular disease (CVD) events. METHODS:We studied left ventricular dimensions and calculated LVA-BSA in 6781 participants of the MESA study (mean age: was 62 ± 10 years, 53% females; 62% non-white) free from prior HF who underwent non-contrast cardiac CT to evaluate the coronary artery calcium score (CAC) at baseline and were followed up for a median of 10.2 years. RESULTS:During follow up, 237 (3.5%) incident HF and 475 (7.0%) CVD events occurred. After adjustment for clinical variables and CAC, LVA-BSA was significantly associated with incident HF (hazard ratio [HR]: 1.10 per 100 mm2/m2, p < 0.001) and CVD events (HR: 1.07 per 100 mm2/m2, p < 0.001). The area under the ROC curve for the prediction of incident HF improved from 0.787 on a model including only risk factors to 0.798 when CAC was added (p = 0.02), and to 0.816 with the additional inclusion of LVA-BSA (p = 0.007). Similar improvements for the prediction of CVD events were noted. CONCLUSION:In an ethnically diverse population of asymptomatic individuals free from baseline CVD or HF, the left ventricular area measured by non-contrast cardiac CT is a strong predictor of incident HF events beyond traditional risk factors and CAC score.

SUBMITTER: Bittencourt MS

PROVIDER: S-EPMC5115932 | biostudies-literature | 2016 Nov - Dec

REPOSITORIES: biostudies-literature

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Left ventricular area on non-contrast cardiac computed tomography as a predictor of incident heart failure - The Multi-Ethnic Study of Atherosclerosis.

Bittencourt Marcio Sommer MS Blankstein Ron R Mao Songshou S Rivera Juan J JJ Bertoni Alain G AG Shaw Leslee J LJ Blumenthal Roger S RS Budoff Matthew J MJ Nasir Khurram K

Journal of cardiovascular computed tomography 20160712 6

<h4>Background</h4>The use of non-contrast cardiac computed tomography measurements to predict heart failure (HF) has not been studied. In the present study we evaluated the prognostic value of left ventricular area adjusted for the body surface area (LVA-BSA) measured by non-contrast cardiac CT to predict incident HF and cardiovascular disease (CVD) events.<h4>Methods</h4>We studied left ventricular dimensions and calculated LVA-BSA in 6781 participants of the MESA study (mean age: was 62 ± 10 ...[more]

PMID: 27499493

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Project description:BACKGROUND:Few studies have reported left ventricular wall findings in contrast-enhanced computed tomography (CE-CT) after extracorporeal cardiopulmonary resuscitation (ECPR). This study examined left ventricular wall CE-CT findings after ECPR and evaluated the association between these findings and the results of coronary angiography and prognosis. METHODS:We evaluated out-of-hospital cardiac arrest patients who were treated with ECPR and subsequently underwent both non-electrocardiography-gated CE-CT and coronary angiography at our center between January 2011 and April 2018. Left ventricular wall CE-CT findings were classified as follows: (1) homogeneously enhanced (HE; the left ventricular wall was homogeneously enhanced), (2) segmental defect (SD; the left ventricular wall was not segmentally enhanced according to the coronary artery territory), (3) total defect (TD; the entire left ventricular wall was not enhanced), and (4) others. Successful weaning from extracorporeal membrane oxygenation, survival to hospital discharge, and predictive ability of significant stenosis on coronary angiography were compared among patients with HE, SD, and TD patterns. RESULTS:A total of 74 patients (median age, 59?years) were eligible, 50 (68%) of whom had initial shockable rhythm. Twenty-three (31%) patients survived to hospital discharge. HE, SD, TD, and other patterns were observed in 19, 33, 11, and 11 patients, respectively. The rates of successful weaning from extracorporeal membrane oxygenation (84% vs. 39% vs. 9%, p?<?0.01) and survival to hospital discharge (47% vs. 27% vs. 0%, p?=?0.02) were significantly different among patients with HE, SD, and TD patterns. In post hoc analysis, patients with HE patterns had a significantly higher success rate of weaning from extracorporeal membrane oxygenation than those with SD and TD patterns. SD predicted significant stenosis with a sensitivity of 74% and specificity of 94%. CONCLUSIONS:Homogenously enhanced left ventricular wall might be a predictor of good left ventricular function recovery. In contrast, total enhancement defect in the entire left ventricular wall was associated with poor outcomes. Contrast defect matching the coronary artery territory could predict significant coronary artery stenosis with good specificity. The left ventricular wall findings in non-electrocardiography-gated CE-CT after ECPR might be useful for diagnosis and prognostic prediction.

Project description:BACKGROUND:Elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) is associated with clinically overt heart failure (HF). However, whether it provides additive prognostic information for incident HF beyond traditional risk factors and left ventricular (LV) mass index among multi-ethnic asymptomatic individuals has not yet been determined. We studied the associations of plasma NT-proBNP and magnetic resonance imaging defined LV mass index with incident HF in an asymptomatic multi-ethnic population. METHODS AND RESULTS:A total of 5597 multi-ethnic participants without clinically apparent cardiovascular disease underwent baseline measurement of NT-proBNP and were followed for 5.5±1.1 years. Among them, 4163 also underwent baseline cardiac magnetic resonance imaging. During follow-up, 111 participants experienced incident HF. Higher NT-proBNP was significantly associated with incident HF, independent of baseline age, sex, ethnicity, systolic blood pressure, diabetes mellitus, smoking, estimated glomerular filtration rate, medications (anti-hypertensive and statin), LV mass index, and interim myocardial infarction (hazard ratio: 1.95 per 1U log NT-proBNP increment, 95% CI 1.54-2.46, P<0.001). This relationship held among different ethnic groups, non-Hispanic whites, African-Americans, and Hispanics. Most importantly, NT-proBNP provided additive prognostic value beyond both traditional risk factors and LV mass index for predicting incident HF (integrated discrimination index=0.046, P<0.001; net reclassification index; 6-year risk probability categorized by <3%, 3-10%, >10% =0.175, P=0.019; category-less net reclassification index=0.561, P<0.001). CONCLUSIONS:Plasma NT-proBNP provides incremental prognostic information beyond traditional risk factors and the magnetic resonance imaging-determined LV mass index for incident symptomatic HF in an asymptomatic multi-ethnic population. CLINICAL TRIAL REGISTRATION:URL: http://www.clinicaltrials.gov. Unique identifier: NCT00005487.

Project description:AimWe assess the improvement in discrimination afforded by the addition of the computed tomography risk markers thoracic aorta calcium (TAC), aortic valve calcification (AVC), mitral annular calcification (MAC), pericardial adipose tissue volume (PAT), and liver attenuation (LA) to the Framingham risk score (FRS) + coronary artery calcium (CAC) for incident coronary heart disease (CHD) and incident cerebrovascular disease (CVD) in a multiethnic cohort.Methods and resultsA total of 5745 participants were enrolled, with 2710 at intermediate Framingham risk, 210 CVD events, and 155 CHD events). Over 9 years of follow up, 251 had adjudicated CHD, 346 had CVD events, and 321 died. The data were analysed using Cox proportional hazard, receiver operator curve (ROC), and net reclassification improvement (NRI) analyses. In the whole cohort and also when the analysis was restricted to only the intermediate-risk participants, CAC, TAC, AVC, and MAC were all significantly associated with incident CVD, incident CHD, and mortality, and CAC had the strongest association. When added to the FRS, CAC had the highest area under the curve (AUC) for the prediction of incident CVD and incident CHD; LA had the least. The addition of TAC, AVC, MAC, PAT, and LA to FRS + CAC all resulted in a significant reduction in AUC for incident CHD (0.712 vs. 0.646, 0.655, 0.652, 0.648, and 0.569; all p < 0.01, respectively) in participants with intermediate FRS. The addition of CAC to FRS resulted in an NRI of 0.547 for incident CHD in the intermediate-risk group. The NRI when TAC, AVC, MAC, PAT, and LA were added to FRS + CAC were 0.024, 0.026, 0.019, 0.012, and 0.012, respectively, for incident CHD in the intermediate-risk group. Similar results were obtained for incident CVD in the intermediate-risk group and also when the whole cohort was used instead of the intermediate FRS group.ConclusionsThe addition of CAC to the FRS provides superior discrimination especially in intermediate-risk individuals compared with the addition of TAC, AVC, MAC, PAT, or LA for incident CVD and incident CHD. Compared with FRS + CAC, the addition of TAC, AVC, MAC, PAT, or LA individually to FRS + CAC worsens the discrimination for incident CVD and incident CHD. These risk markers are unlikely to be useful for improving cardiovascular risk prediction.

Dataset Information

Left ventricular area on non-contrast cardiac computed tomography as a predictor of incident heart failure - The Multi-Ethnic Study of Atherosclerosis.

Publications

Left ventricular area on non-contrast cardiac computed tomography as a predictor of incident heart failure - The Multi-Ethnic Study of Atherosclerosis.

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