BACKGROUND The predictive value of ascending aortic distensibility (AAD) for mortality and hard cardiovascular disease (CVD) events is not fully established. OBJECTIVES We sought to assess the utility of AAD to predict mortality and incident CVD events beyond conventional risk factors in the Multi-Ethnic Study of Atherosclerosis (MESA). METHODS AAD was measured with magnetic resonance imaging at baseline in 3,675 MESA participants free of overt CVD. Cox proportional-hazards regression was used to evaluate risk of death, heart failure (HF), and incident CVD in relation to AAD, CVD risk factors, indices of subclinical atherosclerosis, and Framingham risk score. RESULTS There were 246 deaths and 171 hard CVD (myocardial infarction, resuscitated cardiac arrest, stroke and cardiovascular [CV] death) and 88 HF events over a median 8.5-year follow-up. Decreased AAD was associated with increased all-cause mortality with a hazard ratio (HR) for the first verus fifth quintile of AAD of 2.7 (p = 0.008) independent of age, sex, ethnicity, other CVD risk factors, and indices of subclinical atherosclerosis. Overall, subjects with lowest AAD had an independent 2-fold risk of hard CVD events. Decreased AAD was associated with CV events in low-to-intermediate CVD risk individuals with an HR for the first quintile of AAD of 5.3 (p = 0.03) as well as with incident HF but not after full adjustment. CONCLUSIONS Decreased proximal aorta distensibility significantly predicts all-cause mortality and hard CV events among individuals without overt CVD. AAD may help refine risk stratification, especially among asymptomatic, low-to-intermediate risk individuals.

Background This study sought to assess cross-sectional associations of aortic stiffness assessed by magnetic resonance imaging (MRI) with left ventricular (LV) remodeling and myocardial deformation in the Multi-Ethnic Study of Atherosclerosis (MESA). Methods and Results Aortic arch pulse wave velocity (PWV) was measured with phase contrast cine MRI. LV circumferential strain (Ecc), torsion, and early diastolic strain rate (EDSR) were determined by tagged MRI. Multivariable linear regression models were used to adjust for demographics and cardiovascular risk factors. Of 2093 participants, multivariable linear regression models demonstrated that higher arch PWV was associated with higher LV mass index (B=0.53 per 1 SD increase for log-transformed PWV, p<0.05) and LV mass to volume ratio (LVMVR) (B=0.015, p<0.01), impaired LV ejection fraction (LVEF) (B=−0.84, p<0.001), Ecc (B=0.55, p<0.001), torsion (B=−0.11, p<0.001), and EDSR (B=−0.003, p<0.05). In sex stratified analysis, higher arch PWV was associated with higher MVR (B=0.02, p<0.05), impaired Ecc (B=0.60, p<0.001) and LVEF (B=−0.45, p<0.05), but with maintained torsion in women, whereas higher PWV was associated with impaired Ecc (B=0.49, p<0.001) and LVEF (B=−1.21, p<0.001) with lower torsion (B=−0.17, p<0.001) in men. Conclusions Higher arch PWV is associated with LV remodeling and reduced LV systolic and diastolic function in a large multi-ethnic population. Greater aortic arch stiffness is associated with concentric LV remodeling, relatively preserved LVEF with maintained torsion in women, whereas greater aortic arch stiffness is associated with greater LV dysfunction demonstrated as impaired Ecc, torsion and LVEF with less concentric LV remodeling in men.

The predictive value of aortic arch pulse wave velocity (PWV) assessed by magnetic resonance imaging (MRI) for cardiovascular disease (CVD) events has not been fully established. The aim of the present study was to evaluate the association of arch PWV with incident CVD events in MESA. Aortic arch PWV was measured using MRI at baseline in 3,527 MESA participants (mean age = 62 ± 10 years at baseline, 47% male) free of overt CVD. Cox regression was used to evaluate the risk of incident CVD (coronary heart disease, stroke, transient ischemic attack, or heart failure) in relation to arch PWV adjusted for age, gender, race, and CVD risk factors. The median value of arch PWV was 7.4 (IQR; 5.6 to 10.2) m/s. There was significant interaction between arch PWV and age for outcomes, so analysis was stratified by age categories (45–54 and over 54 years). There were 456 CVD events over the 10-year follow-up. 45–54 year-old participants had significant association of arch PWV with incident CVD independent of CVD risk factors (HR, 1.44; 95% confidence interval, 1.07 to 1.95; p=0.018; per 1SD increase for logarithmically transformed PWV), whereas over 54 years group did not (p=0.93). Aortic arch PWV assessed by MRI is a significant predictor of CVD events among middle-aged (45 to 54 years old) individuals, whereas arch PWV is not associated with CVD among an elderly in a large multi-ethnic population.