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Left ventricular shape predicts different types of cardiovascular events in the general population
  1. Bharath Ambale-Venkatesh1,
  2. Kihei Yoneyama1,
  3. Ravi K Sharma1,
  4. Yoshiaki Ohyama1,
  5. Colin O Wu2,
  6. Gregory L Burke3,
  7. Steven Shea4,
  8. Antoinette S Gomes5,
  9. Alistair A Young6,
  10. David A Bluemke2,
  11. João AC Lima1
  1. 1Johns Hopkins University, Baltimore, Maryland, USA
  2. 2National Institutes of Health, Bethesda, Maryland, USA
  3. 3Wake Forest University Health Sciences, Winston-Salem, North Carolina, USA
  4. 4Columbia University, New York, New York, USA
  5. 5University of California at Los Angeles, Los Angeles, California, USA
  6. 6University of Auckland, Auckland, New Zealand
  1. Correspondence to Dr Bharath Ambale-Venkatesh, MR 110 Radiology, Johns Hopkins University, Nelson Basement, 600 N Wolfe Street, Baltimore MD 21287, USA; bambale1{at}jhmi.edu

Abstract

Objective To investigate whether sphericity volume index (SVI), an indicator of left ventricular (LV) remodelling, predicts incident cardiovascular events (coronary heart disease, CHD; all cardiovascular disease, CVD; heart failure, HF; atrial fibrillation, AF) over 10 years of follow-up in a multiethnic population (Multi-Ethnic Study of Atherosclerosis).

Methods 5004 participants free of known CVD had magnetic resonance imaging (MRI) in 2000–2002. Cine images were analysed to compute, Graphic equivalent to LV volume/volume of sphere with length of LV as the diameter. The highest (greatest sphericity) and lowest (lowest sphericity) quintiles of SVI were compared against the reference group (2–4 quintiles combined). Risk-factor adjusted hazard's ratio (HR) from Cox regression assessed the predictive performance of SVI at end-diastole (ED) and end-systole (ES) to predict incident outcomes over 10 years in retrospective interpretation of prospective data.

Results At baseline, participants were aged 61±10 years; 52% men and 39%/13%/26%/22% Cauc/Chinese/Afr-Amer/Hispanic. Low sphericity was associated with higher Framingham CVD risk, greater coronary calcium score and higher N-terminal pro-brain natriuretic peptide (NT-proBNP); while increased sphericity was associated with higher NT-proBNP and lower ejection fraction. Low sphericity predicted incident CHD (HR: 1.48, 1.55–2.59 at ED) and CVD (HR: 1.82, 1.47–2.27 at ED). However, both low (HR: 1.81, 1.20–2.73 at ES) and high (HR: 2.21, 1.41–3.46 at ES) sphericity predicted incident HF. High sphericity also predicted AF.

Conclusions In a multiethnic population free of CVD at baseline, lowest sphericity was a predictor of incident CHD, CVD and HF over a 10-year follow-up period. Extreme sphericity was a strong predictor of incident HF and AF. SVI improved risk prediction models beyond established risk factors only for HF, but not for all CVD or CHD.

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