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 computed tomography (nCT) 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 nCT to predict incident HF and cardiovascular disease (CVD) events. Methods We studied 6781 participants (mean age: was 62 ± 10 years, 53% females; 62% non-white) free from prior HF in the MESA study who underwent nCT to evaluate left ventricular dimensions and coronary artery calcium score (CAC) at baseline and were followed up for a median of 10.2 years. The LVA-BSA was measured in nCT as previously validated. Results During follow up, 237 (3.5%) incident HF and 475 (7.0%) CVD events occurred. After adjustment for clinical variables and CAC, the 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 improvement in the prediction of CVD events was noted. Conclusion In an ethnically diverse population of asymptomatic individuals free from baseline CVD or HF, the left ventricular area measured by nCT is a strong predictor of incident HF events beyond traditional risk factors and CAC score.

The Implication of Coronary Artery Calcium Testing for Cardiovascular Disease Prevention and Diabetes

“…Recent studies have shown that increased CAC is associated with higher rate of cerebrovascular accidents [3536], heart failure [3738], and atrial fibrillation [39]. In addition, compared to individuals who have no CAC, those with increased CAC are more likely to have other non-cardiac conditions such as cancer, chronic kidney disease, chronic obstructive pulmonary disease, and hip fractures [40].…”

Imaging predictors of incident heart failure: a systematic review and meta-analysis

“…A substantially lower number of studies considered findings from CMR or CCT, reflecting the still limited availability and relatively high costs of these techniques with 11 respect to TTE. Several imaging modalities were investigated in the MESA cohort (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18), although no head-to-head comparison between the different techniques has been carried out so far.…”

“…In a CCT study on the same population, left ventricular area [measured in mid-diastole and normalized for body surface area (BSA)] displayed a significant association with incident heart failure (hazard ratio 1.10 per 100 mm 2 /m 2 , P < 0.001) after adjustment for clinical variables and coronary artery calcium (CAC) score. 8 Conversely, left ventricular end-diastolic diameter at baseline did not independently predict incident including heart failure among elderly individuals. 34 Regarding left ventricular shape, a high index of sphericity on CMR imaging was a strong, independent predictor of heart failure in a model, including clinical variables, left ventricular end-diastolic volume index, left ventricular mass index, LVEF and N-terminal fraction of pro-B-type natriuretic peptide (hazard ratio 2.13, 95% CI 1.30-3.49).…”

“…This knowledge is also instrumental for planning studies testing interventions aiming at minimizing the progression from asymptomatic (stages A and B) to overt heart failure (stages C and D). To date, several studies on asymptomatic individuals have explored the predictive value of a single or few imaging parameters using a specific imaging modality in heterogeneous populations, 6–37 but a comprehensive evaluation is lacking.…”

Small whole heart volume predicts cardiovascular events in patients with stable chest pain: insights from the PROMISE trial

“…Advanced CAD phenotyping, incorporating these structures, may leverage additional information and improve risk stratification. For example, epicardial adipose tissue, size of individual cardiac chambers, or CT-derived cardiac function has been related to adverse CV events beyond coronary stenosis and clinical risk factors [7][8][9][10].…”