Relation of the Myocardial Contraction Fraction, as Calculated from M-Mode Echocardiography, With Incident Heart Failure, Atherosclerotic Cardiovascular Disease and Mortality (Results from the Cardiovascular Health Study)

Introduction: The myocardial contraction fraction (MCF), the ratio of LV stroke volume (SV) to myocardial volume (MV), is a volumetric measure of myocardial shortening. With 3D-echocardiography and MRI, MCF distinguished pathologic from physiologic hypertrophy and predicted incident CV events. However, the association between 2D echo-determined MCF and adverse CV outcomes is not known, nor has the premise that this ratio adequately captures the predictive information of its components, SV and MV, been tested. Methods: Using CHS data, we calculated MCF from 2-D guided M-mode echo dimensions to estimate LV volumes and SV. MV was estimated from the measurements of LV mass divided by myocardial density. Among individuals with a normal EF, Cox regression was used to examine the associations between MCF with incident heart failure (HF), cardiovascular disease (CVD), and all-cause mortality adjusting for clinical and echo parameters. We further examined the validity of the premise that log(SV) and log(MV) contribute in the expected ratio of 1: -1 with our outcomes of interest. Results: 1556 participants were identified with an EF ≥ 55% (age 72±5) that had baseline echo data and available covariate information. MCF averaged 58% (Range: 21-104%). After controlling for CV, clinical risk factors, echo variables and NT-proBNP, a 10% relative increase in MCF was significantly associated with reduced risk of HF, CVD and death. When included separately in the models, both MV and SV showed significant associations with CVD and death, however, only MV was significant for HF and the coefficients violated the 1:-1 ratio suggesting MCF is not the best way to model this relationship. Conclusions: Among older adults with normal EF, 2D-echo MCF was associated with a lower risk of adverse CV outcomes after adjustment for clinical factors, echo parameters, and NT-proBNP. However, MCF compared to its component measures might be inadequate for risk prediction in HF.

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Serial Biomarkers of De Novo Lipogenesis Fatty Acids and Incident Heart Failure in Older Adults: The Cardiovascular Health Study

Journal of the American Heart Association ◽

10.1161/jaha.119.014119 ◽

2020 ◽

Vol 9 (4) ◽

Cited By ~ 1

Author(s):

Yujin Lee ◽

Heidi T. M. Lai ◽

Marcia C. de Oliveira Otto ◽

Rozenn N. Lemaitre ◽

Barbara McKnight ◽

...

Keyword(s):

Heart Failure ◽

Older Adults ◽

Fatty Acids ◽

Cardiovascular Health ◽

De Novo ◽

De Novo Lipogenesis ◽

Health Study ◽

Cardiovascular Health Study ◽

Incident Heart Failure

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Race, Gender, and Mortality in Adults ≥65 Years of Age With Incident Heart Failure (from the Cardiovascular Health Study)

The American Journal of Cardiology ◽

10.1016/j.amjcard.2008.12.043 ◽

2009 ◽

Vol 103 (8) ◽

pp. 1120-1127 ◽

Cited By ~ 40

Author(s):

Susmita Parashar ◽

Ronit Katz ◽

Nicholas L. Smith ◽

Alice M. Arnold ◽

Viola Vaccarino ◽

...

Keyword(s):

Heart Failure ◽

Cardiovascular Health ◽

Health Study ◽

Cardiovascular Health Study ◽

Incident Heart Failure

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Longitudinal Measures of Trimethylamine N-oxide and Incident Atherosclerotic Cardiovascular Disease Events in Older Adults: The Cardiovascular Health Study

Current Developments in Nutrition ◽

10.1093/cdn/nzaa061_062 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 1434-1434

Author(s):

Yujin Lee ◽

Zeneng Wang ◽

Heidi Lai ◽

Marcia de Oliveira Otto ◽

Rozenn Lemaitre ◽

...

Keyword(s):

Cardiovascular Disease ◽

Older Adults ◽

Renal Function ◽

Cystatin C ◽

Impaired Renal Function ◽

Cardiovascular Health ◽

Health Study ◽

Cardiovascular Health Study ◽

Atherosclerotic Cardiovascular Disease ◽

Community Based

Abstract Objectives Trimethylamine N-oxide (TMAO) is a gut microbiota-dependent metabolite of dietary choline, L-carnitine and phosphatidylcholine-rich animal foods. Based on experimental studies and cohorts with prevalent disease, elevated TMAO may increase risk of atherosclerotic cardiovascular disease (ASCVD). TMAO is also renally cleared and may interact with and causally contribute to renal dysfunction and elevated cystatin-C. Yet, the associations of serial TMAO levels with incident ASCVD in a community-based prospective cohort, and the potential mediating and modifying role of renal function, are not established. Methods We investigated the associations of serial measures of plasma TMAO, assessed at baseline and 7 years post baseline, with incident ASCVD among 4144 older adults in the Cardiovascular Health Study (CHS). TMAO was measured using stable isotope dilution LC/MS/MS (lab CV <6%). Incident ASCVD (myocardial infarction, fatal coronary heart disease, stroke, sudden cardiac death, or other atherosclerotic death) was centrally adjudicated using medical records. Risk was assessed by multivariable Cox proportional hazards regression including time-varying demographics, lifestyle factors, medical history, and laboratory and dietary variables. We assessed potential mediating effects and interaction by renal function estimated by cystatin-C. Results During a median 15 years follow-up, 1757 ASCVD events occurred. After multivariable adjustment, TMAO was associated with a higher risk of ASCVD, with an extreme quintile HR (95% CI) of 1.22 (1.04, 1.44), P-trend = 0.01. This relationship appeared further mediated or confounded by estimated glomerular filtration rate (eGFR): adjusting for cystatin-C-based eGFR, the HR (95% CI) was 1.06 (0.98–1.25). Significant interaction was also observed by renal function (P-interaction < 0.001), with TMAO associated with higher risk of ASCVD among individuals with impaired renal function (eGFR ≤ 60) [1.63 (1.03–2.59)], but not normal baseline renal function (eGFR > 60) [1.15 (0.96–1.37)], even with further adjustment for continuous eGFR. Conclusions In this large community-based cohort of older US adults, higher serial measures of TMAO were associated with an elevated risk of ASCVD, in particular among those with impaired renal function. Funding Sources NIH, NHLBI.

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Abstract 04: Incident Heart Failure and Longitudinal Cognitive Trajectories in the Cardiovascular Health Study

Circulation ◽

10.1161/circ.131.suppl_1.04 ◽

2015 ◽

Vol 131 (suppl_1) ◽

Author(s):

Christa Schank ◽

Natalie J Blades ◽

Sarwat I Chaudhry ◽

John A Dodson ◽

W T Longstreth ◽

...

Keyword(s):

Heart Failure ◽

Older Adults ◽

Cognitive Decline ◽

Cardiovascular Health ◽

Self Report ◽

Cognitive Test ◽

Health Study ◽

Cardiovascular Health Study ◽

Incident Heart Failure ◽

Rate Of Decline

OBJECTIVE: To determine whether older adults who develop incident heart failure (HF) experience faster cognitive decline than those without HF. METHODS: We analyzed longitudinal cognitive test data from the Cardiovascular Health Study, a community-based study of adults aged 65 years and older. Participants in this analysis did not have HF or history of stroke at baseline and were censored when they experienced incident clinical stroke. Incident HF was identified by self-report of physician-diagnosed HF and confirmed by adjudicated review of inpatient and outpatient medical records and medication use. Outcomes were mean score and rate of decline in mean score on the 100-point Modified Mini-Mental State Examination (3MSE), administered annually up to nine times from 1990 to 1998. A linear mixed effects model was used to model the relationship of cognitive decline with HF and age, adjusted for demographics, health behaviors, and comorbid conditions including hypertension and diabetes. RESULTS: Analyses included 5,211 participants with mean age 74 years at baseline, of whom 545 (10.5%) developed incident HF over a median follow-up of 7.8 years. Mean 3MSE score was lower at the time of HF diagnosis compared with no HF, and declined faster after incident HF compared with no HF. For example, at age 80, covariate-adjusted predicted mean 3MSE score was 88.6 points (95% CI: 88.3, 89.0) in participants without HF, but 87.6 points (95% CI: 87.3, 87.9) in those with newly diagnosed HF. Predicted five-year decline in mean 3MSE score from age 80 to age 85 was 5.9 points (95% CI: 5.7, 6.0) in participants without HF, but 10.0 points (95% CI: 8.6, 11.3) in those diagnosed with incident HF at age 80. Faster decline in 3MSE score after HF diagnosis was seen at all ages studied. The figure shows predicted mean 3MSE score trajectories without HF (solid line) and after HF diagnosed at ages 70, 75, 80, and 85 (dashed lines), with 95% CI shaded. CONCLUSIONS: Older adults diagnosed with incident HF experience faster average cognitive decline than those without HF.

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