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Age-related left ventricular remodeling and associated risk for cardiovascular outcomes: the Multi-Ethnic Study of Atherosclerosis.
Circ Cardiovasc Imaging 2009; 2(3):191-8CC

Abstract

BACKGROUND

Age-related alterations of left ventricular (LV) structure and function that may predispose to cardiovascular events are not well understood.

METHODS AND RESULTS

We used cardiac MRI to examine age-related differences in LV structure and function in 5004 participants without overt cardiovascular disease when enrolled in the Multi-Ethnic Study of Atherosclerosis; 1099 participants received additional strain analyses by MRI tagging. We also assessed the relation of age-associated remodeling with cardiovascular outcomes using Cox proportional hazard models adjusting for cardiovascular risk factors. Although LV mass decreased with age (-0.3 g per year), the mass-to-volume ratio markedly increased (+5 mg/mL per year, P<0.0001), driven by a substantial reduction in end-diastolic volume (-0.8 mL per year, P<0.0001). Age was also associated with a significant fall in stroke volume (-0.4 mL per year, P<0.0001), along with strain patterns reflecting systolic (P<0.0001) as well as diastolic (P<0.01) myocardial dysfunction-despite a modestly enhanced ejection fraction (+0.1% per year, P<0.0001). Increased mass-to-volume ratio conferred a significant risk for total cardiovascular events; this trend was strongest among younger (<65 years; hazard ratio, 3.69 [CI, 1.34 to 10.10]) versus older (> or =65 years; hazard ratio, 1.68 [CI 0.77 to 3.68]) individuals with the highest compared to lowest mass-to-volume ratio quintile (P(interaction)=0.013).

CONCLUSIONS

Age is associated with a phenotype of LV remodeling marked by increased mass-to-volume ratio and accompanied by systolic as well as diastolic myocardial dysfunction that is not reflected by preserved ejection fraction. This pattern of ventricular remodeling confers significant cardiovascular risk, particularly when present earlier in life.

Authors+Show Affiliations

Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Md., USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19808592

Citation

Cheng, Susan, et al. "Age-related Left Ventricular Remodeling and Associated Risk for Cardiovascular Outcomes: the Multi-Ethnic Study of Atherosclerosis." Circulation. Cardiovascular Imaging, vol. 2, no. 3, 2009, pp. 191-8.
Cheng S, Fernandes VR, Bluemke DA, et al. Age-related left ventricular remodeling and associated risk for cardiovascular outcomes: the Multi-Ethnic Study of Atherosclerosis. Circ Cardiovasc Imaging. 2009;2(3):191-8.
Cheng, S., Fernandes, V. R., Bluemke, D. A., McClelland, R. L., Kronmal, R. A., & Lima, J. A. (2009). Age-related left ventricular remodeling and associated risk for cardiovascular outcomes: the Multi-Ethnic Study of Atherosclerosis. Circulation. Cardiovascular Imaging, 2(3), pp. 191-8. doi:10.1161/CIRCIMAGING.108.819938.
Cheng S, et al. Age-related Left Ventricular Remodeling and Associated Risk for Cardiovascular Outcomes: the Multi-Ethnic Study of Atherosclerosis. Circ Cardiovasc Imaging. 2009;2(3):191-8. PubMed PMID: 19808592.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Age-related left ventricular remodeling and associated risk for cardiovascular outcomes: the Multi-Ethnic Study of Atherosclerosis. AU - Cheng,Susan, AU - Fernandes,Verônica R S, AU - Bluemke,David A, AU - McClelland,Robyn L, AU - Kronmal,Richard A, AU - Lima,João A C, Y1 - 2009/03/26/ PY - 2009/10/8/entrez PY - 2009/10/8/pubmed PY - 2009/10/27/medline SP - 191 EP - 8 JF - Circulation. Cardiovascular imaging JO - Circ Cardiovasc Imaging VL - 2 IS - 3 N2 - BACKGROUND: Age-related alterations of left ventricular (LV) structure and function that may predispose to cardiovascular events are not well understood. METHODS AND RESULTS: We used cardiac MRI to examine age-related differences in LV structure and function in 5004 participants without overt cardiovascular disease when enrolled in the Multi-Ethnic Study of Atherosclerosis; 1099 participants received additional strain analyses by MRI tagging. We also assessed the relation of age-associated remodeling with cardiovascular outcomes using Cox proportional hazard models adjusting for cardiovascular risk factors. Although LV mass decreased with age (-0.3 g per year), the mass-to-volume ratio markedly increased (+5 mg/mL per year, P<0.0001), driven by a substantial reduction in end-diastolic volume (-0.8 mL per year, P<0.0001). Age was also associated with a significant fall in stroke volume (-0.4 mL per year, P<0.0001), along with strain patterns reflecting systolic (P<0.0001) as well as diastolic (P<0.01) myocardial dysfunction-despite a modestly enhanced ejection fraction (+0.1% per year, P<0.0001). Increased mass-to-volume ratio conferred a significant risk for total cardiovascular events; this trend was strongest among younger (<65 years; hazard ratio, 3.69 [CI, 1.34 to 10.10]) versus older (> or =65 years; hazard ratio, 1.68 [CI 0.77 to 3.68]) individuals with the highest compared to lowest mass-to-volume ratio quintile (P(interaction)=0.013). CONCLUSIONS: Age is associated with a phenotype of LV remodeling marked by increased mass-to-volume ratio and accompanied by systolic as well as diastolic myocardial dysfunction that is not reflected by preserved ejection fraction. This pattern of ventricular remodeling confers significant cardiovascular risk, particularly when present earlier in life. SN - 1942-0080 UR - https://www.unboundmedicine.com/medline/citation/19808592/Age_related_left_ventricular_remodeling_and_associated_risk_for_cardiovascular_outcomes:_the_Multi_Ethnic_Study_of_Atherosclerosis_ L2 - http://www.ahajournals.org/doi/full/10.1161/CIRCIMAGING.108.819938?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -