Prognosis of Individuals With Asymptomatic Left Ventricular Systolic Dysfunction in the Multi-Ethnic Study of Atherosclerosis (MESA)

Study Questions:

What are the characteristics and prognosis of individuals free of prior cardiovascular disease (CVD) and with asymptomatic left ventricular systolic dysfunction (ALVSD) assessed using cardiac magnetic resonance imaging (MRI)?


This was an analysis from the Multi-Ethnic Study of Atherosclerosis (MESA), a prospective cohort study begun in 2000, to assess progression of subclinical CVD in individuals without known CVD at baseline. Statistical analyses were used to assess the association between ALVSD, defined as left ventricular ejection fraction (LVEF) <50%, and adjudicated 9-year incidence of congestive heart failure (CHF), all-cause mortality, and CVD events.


The overall prevalence of ALVSD was 1.7%, with a higher 2.6% prevalence in African Americans. ALVSD was associated with increased risk in unadjusted and adjusted models for incident CHF [hazard ratio (HR) (95%): 12.0 (7.04-20.3), p < 0.0001 and 8.69 (4.89-15.45), p < 0.001, respectively], CVD [HR (95%): 3.32 (1.98-5.58), p < 0.001 and 2.21 (1.30-3.73), p = 0.003, respectively], and all-cause mortality [HR (95%): 3.47 (2.03-5.94), p < 0.0001 and 2.00 (1.13-3.54), p = 0.017, respectively]. Adding LV mass index (LVMI) to LVEF improved the discriminative ability for incident CHF [c-index (95%): 0.67 (0.51-0.84)].


Although uncommon in those without prior CVD, ALVSD is associated with a higher risk of adverse CV outcomes.


Compared to other studies that may have been limited by heterogeneity in study design, setting, and samples, the present observational study of a multi-ethnic adult population free of CVD at baseline provides a plausible and reliable indication of the burden imposed by ALVSD. With a prevalence of 1.7%, ALVSD, although associated with significant morbidity, is uncommon. And, while the authors suggest that LVMI may be a good screening tool for identifying individuals with ALVSD who would develop CHF, the practicality and cost-effectiveness of this approach with the use of MRI should be questioned for a relatively uncommon entity.

Clinical Topics: Heart Failure and Cardiomyopathies, Noninvasive Imaging, Magnetic Resonance Imaging

Keywords: Prognosis, Cardiovascular Diseases, Ventricular Dysfunction, Left, Magnetic Resonance Imaging

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