Clinical Outcomes and Prognosis
Theo Pezel, MD
Head of the Cardiovascular Imaging department
Lariboisiere University Hospital, APHP, Paris, France
Paris, Ile-de-France, France
Theo Pezel, MD
Head of the Cardiovascular Imaging department
Lariboisiere University Hospital, APHP, Paris, France
Paris, Ile-de-France, France
Erin Michos, MD, PhD
Cardiologist
Division of Cardiology, Johns Hopkins University, Baltimore, Maryland 21287-0409, USA., United States
Vinithra Varadarajan, MD
Cardiologist
Division of Cardiology, Johns Hopkins University, Baltimore, Maryland 21287-0409, USA., United States
Mahsima Shabani, PhD
Research Scientist
Division of Cardiology, Johns Hopkins University, Baltimore, Maryland 21287-0409, USA., United States
Bharath Ambale-Venkatesh, PhD
Physicist
The John Hopkins Hospital
Baltimore, Maryland, United States
Dhananjay Vaidya, MD, PhD
Physician
Department of Medicine Division of General Medicine, The Johns Hopkins University, Baltimore, MD, United States, United States
Yoko Kato, MD, PhD
Research Fellow
The Johns Hopkins University
Baltimore, Maryland, United States
Henrique De Vasconcellos, MD, PhD
Cardiologist
Division of Cardiology, Johns Hopkins University, Baltimore, Maryland 21287-0409, USA, United States
Susan Heckbert, MD, PhD
Physician
4. Department of Epidemiology, University of Washington, Seattle, WA, USA, United States
Colin Wu
Biostatician
NIH
Bethesda, Maryland, United States
Wendy Post, MD, MSc
Cardiology / Professor
The John Hopkins Hospital, United States
David A. Bluemke, MD
MD
University of Wisconsin-Madison
Madison, Wisconsin, United States
Matthew Allison, MD, PhD
Physician
Division of Preventive Medicine, Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, United States of America, United States
Joao A. C Lima, MD
MD
The John Hopkins Hospital
Baltimore, Maryland, United States
Sex hormones associated with both the left atrial (LA) and left ventricular (LV) structures in women, but the association of menopause status with left atrioventricular coupling is not established. The aime of the study was to assess the prognostic value of a left atrioventricular coupling index (LACI) in peri-menopausal women without a history of cardiovascular disease (CVD).
Methods: In all women participating in MESA study with baseline cardiovascular MRI, the LACI was measured as the ratio of the LA end-diastolic volume to the LV end-diastolic volume. Cox models were used to assess the association between the LACI and the outcomes of atrial fibrillation (AF), heart failure (HF), coronary heart disease (CHD) death, and hard CVD.
Results:
Among the 2,087 women participants (61±10 years), 485 cardiovascular events occurred (mean follow-up: 13.2±3.3 years). A higher LACI was independently associated with AF (HR 1.70; 95%CI [1.51-1.90]), HF (HR 1.62; [1.33-1.97]), CHD death (HR 1.36; [1.10-1.68]), and hard CVD (HR 1.30; [1.13-1.51], all p< 0.001). Adjusted models with the LACI showed significant improvement in model discrimination and reclassification when compared to traditional models to predict: incident AF (C-statistic: 0.82 vs. 0.79; NRI=0.325; IDI=0.036), HF (C-statistic: 0.84 vs. 0.81; NRI=0.571; IDI=0.023), CHD death (C-statistic: 0.87 vs. 0.85; NRI=0.506; IDI=0.012), hard CVD (C-statistic: 0.78 vs. 0.76; NRI=0.229; IDI=0.012). The prognostic value of the LACI had a better discrimination and reclassification than individual LA or LV parameters.
Conclusion:
In a multi-ethnic population of pre- and post-menopausal women, the LACI is an independent predictor of HF, AF, CHD death, and hard CVD.