Left ventricular global function index predicts incident heart failure and cardiovascular disease in young adults

The coronary artery risk development in young adults (CARDIA) study

Chike C. Nwabuo, Henrique T. Moreira, Henrique D. Vasconcellos, Nathan Mewton, Anders Opdahl, Kofo O. Ogunyankin, Bharath Ambale-Venkatesh, Pamela J Schreiner, Anderson A.C. Armstrong, Cora E. Lewis, David R Jacobs Jr, Donald Lloyd-Jones, Samuel S. Gidding, João A.C. Lima

Research output: Contribution to journalArticle

Abstract

Aims: Left ventricular (LV) ejection fraction (LVEF) is an extensively utilized marker of LV function that is often interpreted without recourse to alterations in LV geometry and hypertrophy. LV global function index (LVGFI) is a novel marker that incorporates LV structure in the assessment of LV cardiac performance. We evaluated the prognostic utility of LVGFI from young adulthood into middle age for incident heart failure (HF) and cardiovascular disease (CVD) in comparison to LVEF. Methods and results: Included were 4107 CARDIA participants with echocardiograms in Year-5 (1990-1991). LVGFI was defined as LV stroke volume/LV global volume∗100, where LV global volume was the sum of the LV mean cavity volume ((LV end-diastolic volume + LV end-systolic volume)/2) and myocardial volume (LV mass/density). Adjusted Cox proportional hazard models were utilized to predict incident HF and CVD outcomes. Mean age of participants was 29.8 ± 3.7 years, 55% female, and 48.7% black. Higher body mass index [beta coefficient (B) = -0.11 standard error (SE) = 0.02, P < 0.001], higher blood pressure (B = -0.04, SE = 0.01, P < 0.01), smoking (B = -0.82, SE = 0.22, P < 0.001), male sex (P < 0.001), and black race (P < 0.001) were associated with worse LVGFI. A total of 207 incident CVD events were observed over the course of 98 035 person-years at risk. Higher LVGFI was associated with HF, hazard ratio (HR) = 0.70, 95% confidence interval (CI) (0.54-0.91), hard CVD HR = 0.83, 95% CI (0.71-0.96), and all CVD HR = 0.83, 95% CI (0.72-0.96). For HF outcomes, Harrell's C-statistic for LVGFI (0.80) was greater than LVEF (0.66). Conclusion: LVGFI is a strong, independent predictor of incident HF and CVD that provides incremental prognostic value compared with LVEF. Male sex, black race, obesity, hypertension, and smoking are associated with worse LVGFI in the early adult lifespan. Published on behalf of the European Society of Cardiology. All rights reserved.

Original languageEnglish (US)
Article numberjey123
Pages (from-to)533-540
Number of pages8
JournalEuropean heart journal cardiovascular Imaging
Volume20
Issue number5
DOIs
StatePublished - Jan 1 2019

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Left Ventricular Function
Young Adult
Heart Diseases
Coronary Vessels
Cardiovascular Diseases
Heart Failure
Stroke Volume
Confidence Intervals
Smoking
Hypertension
Left Ventricular Hypertrophy
Proportional Hazards Models
Body Mass Index
Obesity

Keywords

  • cardiac function
  • cardiac structure
  • early adulthood
  • heart failure
  • left ventricular ejection fraction
  • left ventricular systolic function

Cite this

Left ventricular global function index predicts incident heart failure and cardiovascular disease in young adults : The coronary artery risk development in young adults (CARDIA) study. / Nwabuo, Chike C.; Moreira, Henrique T.; Vasconcellos, Henrique D.; Mewton, Nathan; Opdahl, Anders; Ogunyankin, Kofo O.; Ambale-Venkatesh, Bharath; Schreiner, Pamela J; Armstrong, Anderson A.C.; Lewis, Cora E.; Jacobs Jr, David R; Lloyd-Jones, Donald; Gidding, Samuel S.; Lima, João A.C.

In: European heart journal cardiovascular Imaging, Vol. 20, No. 5, jey123, 01.01.2019, p. 533-540.

Research output: Contribution to journalArticle

Nwabuo, CC, Moreira, HT, Vasconcellos, HD, Mewton, N, Opdahl, A, Ogunyankin, KO, Ambale-Venkatesh, B, Schreiner, PJ, Armstrong, AAC, Lewis, CE, Jacobs Jr, DR, Lloyd-Jones, D, Gidding, SS & Lima, JAC 2019, 'Left ventricular global function index predicts incident heart failure and cardiovascular disease in young adults: The coronary artery risk development in young adults (CARDIA) study', European heart journal cardiovascular Imaging, vol. 20, no. 5, jey123, pp. 533-540. https://doi.org/10.1093/ehjci/jey123
Nwabuo, Chike C. ; Moreira, Henrique T. ; Vasconcellos, Henrique D. ; Mewton, Nathan ; Opdahl, Anders ; Ogunyankin, Kofo O. ; Ambale-Venkatesh, Bharath ; Schreiner, Pamela J ; Armstrong, Anderson A.C. ; Lewis, Cora E. ; Jacobs Jr, David R ; Lloyd-Jones, Donald ; Gidding, Samuel S. ; Lima, João A.C. / Left ventricular global function index predicts incident heart failure and cardiovascular disease in young adults : The coronary artery risk development in young adults (CARDIA) study. In: European heart journal cardiovascular Imaging. 2019 ; Vol. 20, No. 5. pp. 533-540.
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abstract = "Aims: Left ventricular (LV) ejection fraction (LVEF) is an extensively utilized marker of LV function that is often interpreted without recourse to alterations in LV geometry and hypertrophy. LV global function index (LVGFI) is a novel marker that incorporates LV structure in the assessment of LV cardiac performance. We evaluated the prognostic utility of LVGFI from young adulthood into middle age for incident heart failure (HF) and cardiovascular disease (CVD) in comparison to LVEF. Methods and results: Included were 4107 CARDIA participants with echocardiograms in Year-5 (1990-1991). LVGFI was defined as LV stroke volume/LV global volume∗100, where LV global volume was the sum of the LV mean cavity volume ((LV end-diastolic volume + LV end-systolic volume)/2) and myocardial volume (LV mass/density). Adjusted Cox proportional hazard models were utilized to predict incident HF and CVD outcomes. Mean age of participants was 29.8 ± 3.7 years, 55{\%} female, and 48.7{\%} black. Higher body mass index [beta coefficient (B) = -0.11 standard error (SE) = 0.02, P < 0.001], higher blood pressure (B = -0.04, SE = 0.01, P < 0.01), smoking (B = -0.82, SE = 0.22, P < 0.001), male sex (P < 0.001), and black race (P < 0.001) were associated with worse LVGFI. A total of 207 incident CVD events were observed over the course of 98 035 person-years at risk. Higher LVGFI was associated with HF, hazard ratio (HR) = 0.70, 95{\%} confidence interval (CI) (0.54-0.91), hard CVD HR = 0.83, 95{\%} CI (0.71-0.96), and all CVD HR = 0.83, 95{\%} CI (0.72-0.96). For HF outcomes, Harrell's C-statistic for LVGFI (0.80) was greater than LVEF (0.66). Conclusion: LVGFI is a strong, independent predictor of incident HF and CVD that provides incremental prognostic value compared with LVEF. Male sex, black race, obesity, hypertension, and smoking are associated with worse LVGFI in the early adult lifespan. Published on behalf of the European Society of Cardiology. All rights reserved.",
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author = "Nwabuo, {Chike C.} and Moreira, {Henrique T.} and Vasconcellos, {Henrique D.} and Nathan Mewton and Anders Opdahl and Ogunyankin, {Kofo O.} and Bharath Ambale-Venkatesh and Schreiner, {Pamela J} and Armstrong, {Anderson A.C.} and Lewis, {Cora E.} and {Jacobs Jr}, {David R} and Donald Lloyd-Jones and Gidding, {Samuel S.} and Lima, {Jo{\~a}o A.C.}",
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TY - JOUR

T1 - Left ventricular global function index predicts incident heart failure and cardiovascular disease in young adults

T2 - The coronary artery risk development in young adults (CARDIA) study

AU - Nwabuo, Chike C.

AU - Moreira, Henrique T.

AU - Vasconcellos, Henrique D.

AU - Mewton, Nathan

AU - Opdahl, Anders

AU - Ogunyankin, Kofo O.

AU - Ambale-Venkatesh, Bharath

AU - Schreiner, Pamela J

AU - Armstrong, Anderson A.C.

AU - Lewis, Cora E.

AU - Jacobs Jr, David R

AU - Lloyd-Jones, Donald

AU - Gidding, Samuel S.

AU - Lima, João A.C.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Aims: Left ventricular (LV) ejection fraction (LVEF) is an extensively utilized marker of LV function that is often interpreted without recourse to alterations in LV geometry and hypertrophy. LV global function index (LVGFI) is a novel marker that incorporates LV structure in the assessment of LV cardiac performance. We evaluated the prognostic utility of LVGFI from young adulthood into middle age for incident heart failure (HF) and cardiovascular disease (CVD) in comparison to LVEF. Methods and results: Included were 4107 CARDIA participants with echocardiograms in Year-5 (1990-1991). LVGFI was defined as LV stroke volume/LV global volume∗100, where LV global volume was the sum of the LV mean cavity volume ((LV end-diastolic volume + LV end-systolic volume)/2) and myocardial volume (LV mass/density). Adjusted Cox proportional hazard models were utilized to predict incident HF and CVD outcomes. Mean age of participants was 29.8 ± 3.7 years, 55% female, and 48.7% black. Higher body mass index [beta coefficient (B) = -0.11 standard error (SE) = 0.02, P < 0.001], higher blood pressure (B = -0.04, SE = 0.01, P < 0.01), smoking (B = -0.82, SE = 0.22, P < 0.001), male sex (P < 0.001), and black race (P < 0.001) were associated with worse LVGFI. A total of 207 incident CVD events were observed over the course of 98 035 person-years at risk. Higher LVGFI was associated with HF, hazard ratio (HR) = 0.70, 95% confidence interval (CI) (0.54-0.91), hard CVD HR = 0.83, 95% CI (0.71-0.96), and all CVD HR = 0.83, 95% CI (0.72-0.96). For HF outcomes, Harrell's C-statistic for LVGFI (0.80) was greater than LVEF (0.66). Conclusion: LVGFI is a strong, independent predictor of incident HF and CVD that provides incremental prognostic value compared with LVEF. Male sex, black race, obesity, hypertension, and smoking are associated with worse LVGFI in the early adult lifespan. Published on behalf of the European Society of Cardiology. All rights reserved.

AB - Aims: Left ventricular (LV) ejection fraction (LVEF) is an extensively utilized marker of LV function that is often interpreted without recourse to alterations in LV geometry and hypertrophy. LV global function index (LVGFI) is a novel marker that incorporates LV structure in the assessment of LV cardiac performance. We evaluated the prognostic utility of LVGFI from young adulthood into middle age for incident heart failure (HF) and cardiovascular disease (CVD) in comparison to LVEF. Methods and results: Included were 4107 CARDIA participants with echocardiograms in Year-5 (1990-1991). LVGFI was defined as LV stroke volume/LV global volume∗100, where LV global volume was the sum of the LV mean cavity volume ((LV end-diastolic volume + LV end-systolic volume)/2) and myocardial volume (LV mass/density). Adjusted Cox proportional hazard models were utilized to predict incident HF and CVD outcomes. Mean age of participants was 29.8 ± 3.7 years, 55% female, and 48.7% black. Higher body mass index [beta coefficient (B) = -0.11 standard error (SE) = 0.02, P < 0.001], higher blood pressure (B = -0.04, SE = 0.01, P < 0.01), smoking (B = -0.82, SE = 0.22, P < 0.001), male sex (P < 0.001), and black race (P < 0.001) were associated with worse LVGFI. A total of 207 incident CVD events were observed over the course of 98 035 person-years at risk. Higher LVGFI was associated with HF, hazard ratio (HR) = 0.70, 95% confidence interval (CI) (0.54-0.91), hard CVD HR = 0.83, 95% CI (0.71-0.96), and all CVD HR = 0.83, 95% CI (0.72-0.96). For HF outcomes, Harrell's C-statistic for LVGFI (0.80) was greater than LVEF (0.66). Conclusion: LVGFI is a strong, independent predictor of incident HF and CVD that provides incremental prognostic value compared with LVEF. Male sex, black race, obesity, hypertension, and smoking are associated with worse LVGFI in the early adult lifespan. Published on behalf of the European Society of Cardiology. All rights reserved.

KW - cardiac function

KW - cardiac structure

KW - early adulthood

KW - heart failure

KW - left ventricular ejection fraction

KW - left ventricular systolic function

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