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CLINICAL RESEARCH: ATHEROSCLEROSIS

Subclinical Atherosclerosis and Incipient Regional Myocardial Dysfunction in Asymptomatic Individuals

The Multi-Ethnic Study of Atherosclerosis (MESA)

Verônica R.S. Fernandes, MD, PhD^_*, Joseph F. Polak, MD, MPH, Thor Edvardsen, MD, PhD^_*, Benilton Carvalho, MSc, Antoinette Gomes, MD, David A. Bluemke, MD, PhD^_*,||, Khurram Nasir, MD, MPH^_*, Daniel H. O’Leary, MD and João A.C. Lima, MD, FACC^_*,||,_*

^_* Division of Cardiology, Johns Hopkins University, Baltimore, Maryland
Division of Radiology, Tufts-New England Medical Center Department of Radiology, Boston, Massachusetts
Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
Department of Radiological Sciences, UCLA Medical Center, Los Angeles, California
^|| Department of Radiology, Johns Hopkins University, Baltimore, Maryland.

Manuscript received June 16, 2005; revised manuscript received August 24, 2005, accepted December 12, 2005.

^_* Reprint requests and correspondence: Dr. João A. C. Lima, The Johns Hopkins Hospital, Blalock 524, 600 North Wolfe Street, Baltimore, Maryland 21287. (Email: jlima{at}jhmi.edu).

OBJECTIVES: This study sought to determine whether increased carotid intima-media thickness (IMT) is related to reduced regional myocardial function in participants of the Multi-Ethnic Study of Atherosclerosis (MESA).

BACKGROUND: Carotid artery IMT is an established index of subclinical atherosclerosis, and tagged magnetic resonance imaging (MRI) can detect incipient alterations of segmental function that precede overt myocardial failure.

METHODS: The MESA study is a prospective observational study including four ethnic groups free from clinical cardiovascular disease. Peak midwall systolic circumferential strain (ECC) and regional strain rates were calculated by harmonic phase from tagged MRI data of 500 participants. Systolic ECC and diastolic strain rate were regressed on IMT of the common carotid artery defined by ultrasound, with adjustments for body mass index, blood pressure, cholesterol, diabetes, smoking, left ventricular hypertrophy, C-reactive protein, age, and gender.

RESULTS: The mean participant age was 66 ± 10 years (mean ± SD). Among the 58 participants, 4% were male and the interquartile (25th to 75th percentile) range for IMT was 0.25 mm. Multiple linear regression analyses showed that increased IMT was related to reduced systolic regional function (less shortening ECC) in all myocardial regions (p < 0.05), except in the inferior wall. The analyses also showed that greater IMT was associated with a lower diastolic strain rate (diastolic reduced function) in all regions (p < 0.01), except in the anterior wall.

CONCLUSIONS: Greater carotid IMT is associated with alterations of myocardial strain parameters reflecting reduced systolic and diastolic myocardial function. These observations indicate a relationship between subclinical atherosclerosis and incipient myocardial dysfunction in a population free of clinical heart disease.

Abbreviations and Acronyms   CAD = coronary artery disease   CHF = congestive heart failure   ECC = circumferential shortening strain   HARP = harmonic phase   HDL = high-density lipoprotein   IMT = intima-media thickness   LV = left ventricular   LVH = left ventricular hypertrophy   MESA = Multi-Ethnic Study of Atherosclerosis   MRI = magnetic resonance imaging   SRE = early diastolic strain rate   SRS = peak systolic strain rate

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