INTRODUCTION: We sought to determine whether subclinical aortic atherosclerosis, detected noninvasively using cardiovascular magnetic resonance (CMR), predicts major adverse cardiovascular events (MACE) in adults without history or clinical manifestation of cardiovascular disease (CVD).
METHODS: 318 Framingham Heart Study (FHS) Offspring cohort members (60±9 yrs, 51% women) underwent CMR in 1998–1999. Subjects were free of clinical CVD and were recruited from equal strata of age, sex and quintile of Framingham Coronary Risk score (FCRS), with double sampling of the top quintile. CMR of the descending aorta on a 1.5-T system used an ECG-triggered black-blood T2W TSE sequence with 1.03 × 0.64 × 5-mm
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voxels, 10-mm gap. Aortic-lumen and plaque areas were hand-traced. MACE included CV death, myocardial infarction (MI), stroke or new heart failure (HF). A Cox proportional hazards model adjusted for FCRS was used to determine hazard ratio (HR) for MACE for the (within-sexes) quartile of subjects with greatest plaque burden (Q4) vs other subjects (Q1–3). Log-rank test was used to compare survival.
RESULTS: CMR aortic atherosclerosis was identified in 38% of women and 41% of men. Over median 5.2-yr follow up, 38 MACE (4 deaths, 14 MIs, 12 strokes, 8 HF) occurred among 31 subjects. Greater plaque burden (Q4) was associated with 2.75-fold greater hazard of MACE (95% CI 1.33 – 5.69, p=0.007). The Figure
shows Kaplan-Meier survival, log-rank p=0.0009.
CONCLUSIONS: In a free-living population without history of cardiovascular disease, CMR evidence of subclinical aortic atherosclerosis was a predictor of 5-year MACE, even after adjustment for traditional cardiovascular risk factors.
Reference values for left atrial size by cardiovascular magnetic resonance in the Framingham Heart Study Offspring cohort
