Relation of the Myocardial Contraction Fraction, as Calculated from M-Mode Echocardiography, With Incident Heart Failure, Atherosclerotic Cardiovascular Disease and Mortality (Results from the Cardiovascular Health Study)

Abstract

We evaluated the association between two-dimensional (2D) echocardiography (echo) determined myocardial contraction fraction (MCF) and adverse cardiovascular outcomes including incident heart failure (HF), atherosclerotic cardiovascular disease (ASCVD) and mortality. The MCF, the ratio of left ventricular (LV) stroke volume (SV) to myocardial volume (MV), is a volumetric measure of myocardial shortening that can distinguish pathologic from physiologic hypertrophy. Using 2D-echo-guided M-mode data from the Cardiovascular Health Study, we calculated MCF among individuals with LV ejection fraction (EF)≥55%, and used Cox models to evaluate its association with incident HF, ASCVD, and all-cause mortality after adjusting for clinical and echo parameters. We assessed whether log2(SV) and log2(MV) were consistent with the expected 1:−1 ratio used in the definition of MCF. Among 2147 participants (age 72±5), average MCF was 59±13%. After controlling for clinical and echo variables, each 10% absolute increment in MCF was associated with lower risk of HF (HR=0.88; 95% CI=0.82, 0.94), ASCVD (HR=0.90; 95% CI=0.85, 0.95) and death (HR=0.93; 95% CI=0.89, 0.97). Moreover, the MCF was still significantly associated with ASCVD and mortality, but not HF, after adjustment for percent predicted LV mass. Significant departure from the 1:−1 ratio was not observed for ASCVD or death, but did occur for HF, driven by a stronger association for MV than SV. In conclusion, among older adults without CVD or low LVEF, 2D-echo-guided M-mode-derived MCF was independently associated with lower risk of adverse cardiovascular outcomes, but this ratiometric index may not capture the full relationship that is apparent when its components are modeled separately in the case of HF.

Myocardial Contraction Fraction by M-Mode Echocardiography Is Superior to Ejection Fraction in Predicting Mortality in Transthyretin Amyloidosis

“…However, the greater availability and lower cost of echocardiography compared to CMR prompted echocardiography-based investigations of the utility of MCF for risk prediction. MCF calculated via 2DE predicted atherosclerotic cardiovascular disease and mortality in patients with no known cardiovascular disease in the Cardiovascular Health Study [7]. MCF using 2D echocardiographic techniques identical to those employed in the current study, predicted mortality in light-chain cardiac amyloidosis (AL-CA) as well [8].…”

“…Myocardial contraction fraction calculated from three-dimensional echocardiography distinguished between physiologic and pathologic hypertrophy [6]. More recently, MCF as calculated based on two-dimensional guided M-mode echocardiography in a community dwelling older adult population was independently associated with adverse cardiovascular outcomes including heart failure, atherosclerotic cardiovascular disease, and death in a population with a normal EF [7]. Since amyloid deposition in the myocardium increases ventricular myocardial volume with subsequent impairment in myocardial shortening, we hypothesized that MCF would be impaired in subjects with ATTR more so than EF and thus, MCF would be a better predictor of mortality.…”

Unveiling outcomes in coexisting severe aortic stenosis and transthyretin cardiac amyloidosis

“…Average mitral annular S′ was calculated from tissue Doppler at the lateral and septal mitral annulus. The myocardial contraction fraction (the ratio of stroke volume to myocardial volume) was measured from linear dimensions in the parasternal long‐axis view as previously described 21 . We derived the voltage‐to‐mass ratio by dividing the electrocardiographic voltage by Sokolow–Lyon criteria by the echocardiographically derived left ventricular cross sectional area 22 .…”

“…The myocardial contraction fraction (the ratio of stroke volume to myocardial volume) was measured from linear dimensions in the parasternal long-axis view as previously described. 21 We derived the voltage-to-mass ratio by dividing the electrocardiographic voltage by Sokolow-Lyon criteria by the echocardiographically derived left ventricular cross sectional area. 22 Stage D1 high-gradient AS was defined by an aortic valve area of <1.0 cm 2 , a peak aortic valve velocity >4 m/s and a mean aortic valve gradient >40 mmHg.…”

Circulating extra-cellular RNAs, myocardial remodeling, and heart failure in patients with acute coronary syndrome

“…Transthoracic echocardiography is a useful noninvasive technique to assess cardiac function and for prognostication of HF [13]. Cardiac remodeling as measured by enlarged cardiac chamber size, lower left ventricular ejection fraction (LVEF) or higher LV mass (LV mass) is associated with the incidence of HF [14-16]. Furthermore, changes in echocardiographic phenotypes are associated with rapid progression of the disease [17].…”