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CLINICAL RESEARCH: CARDIOVASCULAR RISK

The Relationship of Left Ventricular Mass and Geometry to Incident Cardiovascular Events

The MESA (Multi-Ethnic Study of Atherosclerosis) Study

David A. Bluemke, MD, PhD^_*,_*, Richard A. Kronmal, PhD, João A.C. Lima, MD^_*, Kiang Liu, PhD, Jean Olson, MD, MPH, Gregory L. Burke, MD, MS^|| and Aaron R. Folsom, MD^¶

^_* Departments of Radiology and Radiological Science and Medicine, Division of Cardiology, School of Medicine, Johns Hopkins University, Baltimore, Maryland
Department of Biostatistics, School of Public Health and Community Medicine, University of Washington, Seattle, Washington
Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
Division of Prevention and Population Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland
^|| Department of Public Health Sciences, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
^¶ Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota

Manuscript received July 3, 2008; revised manuscript received August 27, 2008, accepted September 4, 2008.

^_* Reprint requests and correspondence: Dr. David A. Bluemke, NIH Clinical Center, Room 10/1C355, Bethesda, Maryland 20892 (Email: bluemked{at}nih.gov).

Objective: The purpose of this study was to evaluate the relationship of left ventricular (LV) mass and geometry measured with cardiac magnetic resonance imaging (MRI) to incident cardiovascular events in the MESA (Multi-Ethnic Study of Atherosclerosis) study.

Background: MRI is highly accurate for evaluation of heart size and structure and has not previously been used in a large epidemiologic study to predict cardiovascular events.

Methods: A total of 5,098 participants in the MESA study underwent cardiac MRI at the baseline examination and were followed up for a median of 4 years. Cox proportional hazard models were constructed to predict the end points of coronary heart disease (CHD), stroke, and heart failure (HF) after adjustment for cardiovascular risk factors.

Results: A total of 216 incident events were observed during the follow-up period. In adjusted models, the end points of incident CHD and stroke were positively associated with increased LV mass-to-volume ratio (CHD, hazard ratio [HR]: 2.1 per g/ml, p = 0.02; stroke, HR: 4.2 per g/ml, p = 0.005). In contrast, LV mass showed the strongest association with incident HF events (HR: 1.4 per 10% increment, p < 0.0001). The HF events occurred primarily in participants with LV hypertrophy, that is, 95th percentile of LV mass (HR: 8.6, 95% confidence interval: 3.7 to 19.9, reference group <50th percentile of LV mass).

Conclusions: The LV size was related to incident HF, stroke, and CHD in this multiethnic cohort. Whereas body size-adjusted LV mass alone predicted incident HF, concentric ventricular remodeling predicted incident stroke and CHD.

Key Words: heart failure • stroke • coronary heart disease • epidemiology • magnetic resonance imaging • left ventricular hypertrophy

Abbreviations and Acronyms   CHD = coronary heart disease   CI = confidence interval   ECG = electrocardiogram   HF = heart failure   HR = hazard ratio   LV = left ventricle/ventricular   LVH = left ventricular hypertrophy   MRI = magnetic resonance imaging

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