Proximal aortic distensibility is an independent predictor of all-cause mortality and incident CV events: The MESA study

Alban Redheuil, Colin O. Wu, Nadjia Kachenoura, Yoshiaki Ohyama, Raymond T. Yan, Alain G. Bertoni, Gregory W. Hundley, Daniel A. Duprez, David R. Jacobs, Lori B. Daniels, Christine Darwin, Christopher Sibley, David A. Bluemke, João A.C. Lima

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70 Scopus citations

Abstract

Background The predictive value of ascending aortic distensibility (AAD) for mortality and hard cardiovascular disease (CVD) events has not been fully established.

Objectives This study sought to assess the utility of AAD to predict mortality and incident CVD events beyond conventional risk factors in MESA (Multi-Ethnic Study of Atherosclerosis).

Methods AAD was measured with magnetic resonance imaging at baseline in 3,675 MESA participants free of overt CVD. Cox proportional hazards regression was used to evaluate risk of death, heart failure (HF), and incident CVD in relation to AAD, CVD risk factors, indexes of subclinical atherosclerosis, and Framingham risk score.

Results There were 246 deaths, 171 hard CVD events (myocardial infarction, resuscitated cardiac arrest, stroke and CV death), and 88 HF events over a median 8.5-year follow-up. Decreased AAD was associated with increased all-cause mortality with a hazard ratio (HR) for the first versus fifth quintile of AAD of 2.7 (p = 0.008) independent of age, sex, ethnicity, other CVD risk factors, and indexes of subclinical atherosclerosis. Overall, patients with the lowest AAD had an independent 2-fold higher risk of hard CVD events. Decreased AAD was associated with CV events in low to intermediate- CVD risk individuals with an HR for the first quintile of AAD of 5.3 (p = 0.03) as well as with incident HF but not after full adjustment.

Conclusions Decreased proximal aorta distensibility significantly predicted all-cause mortality and hard CV events among individuals without overt CVD. AAD may help refine risk stratification, especially among asymptomatic, low- to intermediate-risk individuals.

Original languageEnglish (US)
Pages (from-to)2619-2629
Number of pages11
JournalJournal of the American College of Cardiology
Volume64
Issue number24
DOIs
StatePublished - Dec 23 2014

Keywords

  • aortic stiffness
  • cardiovascular risk
  • magnetic resonance imaging
  • mortality

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    Redheuil, A., Wu, C. O., Kachenoura, N., Ohyama, Y., Yan, R. T., Bertoni, A. G., Hundley, G. W., Duprez, D. A., Jacobs, D. R., Daniels, L. B., Darwin, C., Sibley, C., Bluemke, D. A., & Lima, J. A. C. (2014). Proximal aortic distensibility is an independent predictor of all-cause mortality and incident CV events: The MESA study. Journal of the American College of Cardiology, 64(24), 2619-2629. https://doi.org/10.1016/j.jacc.2014.09.060