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Adverse cardiac mechanics and incident coronary heart disease in the Cardiovascular Health Study
  1. Daniele Massera1,
  2. Mo Hu2,
  3. Joseph A Delaney3,
  4. Traci M Bartz4,
  5. Megan E Bach2,
  6. Stephen J Dvorak2,
  7. Christopher R DeFilippi5,
  8. Bruce M Psaty6,
  9. John S Gottdiener7,
  10. Jorge R Kizer8,
  11. Sanjiv J Shah2
  1. 1Leon H. Charney Division of Cardiology, NYU Langone Health, New York, New York, USA
  2. 2Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  3. 3College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
  4. 4Department of Biostatistics, University of Washington, Seattle, Washington, USA
  5. 5Inova Heart and Vascular Institute, Falls Church, Virginia, USA
  6. 6Cardiovascular Health Research Unit, Departments of Epidemiology, Medicine, and Health Services, University of Washington, Seattle, Washington, USA
  7. 7Division of Cardiology, Department of Medicine, University of Maryland, Baltimore, Maryland, USA
  8. 8Departments of Medicine, Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
  1. Correspondence to Dr Sanjiv J Shah, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; sanjiv.shah{at}


Objectives Speckle-tracking echocardiography enables detection of abnormalities in cardiac mechanics with higher sensitivity than conventional measures of left ventricular (LV) dysfunction and may provide insight into the pathogenesis of coronary heart disease (CHD). We investigated the relationship of LV longitudinal strain, LV early diastolic strain rate (SR) and left atrial (LA) reservoir strain with long-term CHD incidence in community-dwelling older adults.

Methods The association of all three strain measures with incidence of non-fatal and fatal CHD (primary outcome of revascularisation, non-fatal and fatal myocardial infarction) was examined in the population-based Cardiovascular Health Study using multivariable Cox proportional hazards models. Follow-up was truncated at 10 years.

Results We included 3313 participants (mean (SD) age 72.6 (5.5) years). During a median follow-up of 10.0 (25th–75th percentile 7.7–10.0) years, 439 CHD events occurred. LV longitudinal strain (HR=1.25 per SD decrement, 95% CI 1.09 to 1.43) and LV early diastolic SR (HR=1.31 per SD decrement, 95% CI 1.14 to 1.50) were associated with a significantly greater risk of incident CHD after adjustment for potential confounders. By contrast, LA reservoir strain was not associated with incident CHD (HR=1.06 per SD decrement, 95% CI 0.94 to 1.19). Additional adjustment for biochemical and echocardiographic measures of myocardial stress, dysfunction and remodelling did not meaningfully alter these associations.

Conclusion We found an association between echocardiographic measures of subclinically altered LV mechanics and incident CHD. These findings inform the underlying biology of subclinical LV dysfunction and CHD. Early detection of asymptomatic myocardial dysfunction may offer an opportunity for prevention and early intervention.

  • echocardiography
  • coronary artery disease
  • epidemiology

Data availability statement

Cardiovascular Health Study data are available upon request (

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Data availability statement

Cardiovascular Health Study data are available upon request (

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  • Twitter @danmassera, @HFpEF

  • Contributors Conception, design, analysis and interpretation of data: DM, MH, JAD, TB, BMP, JSG, JRK and SJS. All authors participated in drafting of the manuscript or revising it critically for important intellectual content. Final approval of the manuscript submitted was granted by all authors.

  • Funding This study was funded by R01 HL107577 from the National Heart, Lung, and Blood Institute (NHLBI) to SJS. This research was also supported by contracts HHSN268201200036C, HHSN268200800007C, HHSN268201800001C, N01HC55222, N01HC85079, N01HC85080, N01HC85081, N01HC85082, N01HC85083, N01HC85086 and 75N92021D00006, and grants U01HL080295 and U01HL130114, from NHLBI, with additional contribution from the National Institute of Neurological Disorders and Stroke (NINDS). Additional support was provided by R01AG023629 from the National Institute on Aging (NIA). A full list of principal CHS investigators and institutions can be found at JRK was supported by K24HL135413 from NHLBI.

  • Competing interests DM has received consulting fees from Bristol Myers Squibb. JRK reports stock ownership in Bristol Myers Squibb, Johnson & Johnson, Medtronic, Merck and Pfizer. SJS has received research grants from Actelion, AstraZeneca, Corvia, Novartis and Pfizer; and has received consulting fees from Abbott, Actelion, AstraZeneca, Amgen, Axon Therapies, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Cardiora, CVRx, Cytokinetics, Eidos, Eisai, GSK, Ionis, Ironwood, Lilly, Merck, MyoKardia, Novartis, Novo Nordisk, Pfizer, Prothena, Sanofi, Shifamed, Tenax and United Therapeutics. All other authors declare that they have no conflicts of interest.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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