Background: Incidence of congestive heart failure is difficult to predict by standard methods. We have developed a method called the signal intensity coefficient that uses echocardiographic texture analysis to quantify microstructural changes which may occur in at-risk patients prior to development of a clinical heart failure syndrome. Methods: Participants from the Framingham Offspring Cohort study who attended the 8th visit and received screening echocardiography were included. Participants were followed for a mean of 7.4 years for incident congestive heart failure. Cox proportional hazards modeling was used to assess the hazard ratio of signal intensity coefficient in the top quartile of values versus other quartiles in the total and sex-stratified population. Results: 2511 participants with interpretable echocardiography and no history of congestive heart failure, stroke, or myocardial infarction were included in this study. The top quartile signal intensity coefficient had a hazard ratio of 1.83 (p=0.0048) for incident heart failure. When additional clinical risk factors were added to the model, this became non-significant. Within women, an elevated hazard ratio was significant in multiple models including age and hypertensive medication use. Models were not significant in men. Conclusions: Elevated signal intensity coefficient is associated with an increased risk of incident congestive heart failure. This trend remains significant in women after inclusion of age and hypertensive medication use. The signal intensity coefficient may be able to identify patients at risk of developing congestive heart failure using echocardiographic texture analysis.
ObjectiveEstablished preclinical imaging assessments of heart failure (HF) risk are based on macrostructural cardiac remodelling. Given that microstructural alterations may also influence HF risk, particularly in women, we examined associations between microstructural alterations and incident HF.MethodsWe studied N=2511 adult participants (mean age 65.7±8.8 years, 56% women) of the Framingham Offspring Study who were free of cardiovascular disease at baseline. We employed texture analysis of echocardiography to quantify microstructural alteration, based on the high spectrum signal intensity coefficient (HS-SIC). We examined its relations to incident HF in sex-pooled and sex-specific Cox models accounting for traditional HF risk factors and macrostructural alterations.ResultsWe observed 94 new HF events over 7.4±1.7 years. Individuals with higher HS-SIC had increased risk for incident HF (HR 1.67 per 1-SD in HS-SIC, 95% CI 1.31 to 2.13; p<0.0001). Adjusting for age and antihypertensive medication use, this association was significant in women (p=0.02) but not men (p=0.78). Adjusting for traditional risk factors (including body mass index, total/high-density lipoprotein cholesterol, blood pressure traits, diabetes and smoking) attenuated the association in women (HR 1.30, p=0.07), with mediation of HF risk by the HS-SIC seen for a majority of these risk factors. However, the HS-SIC association with HF in women remained significant after adjusting for relative wall thickness (representing macrostructure alteration) in addition to these risk factors (HR 1.47, p=0.02).ConclusionsCardiac microstructural alterations are associated with elevated risk for HF, particularly in women. Microstructural alteration may identify sex-specific pathways by which individuals progress from risk factors to clinical HF.
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