Suma H Konety1, Ryan J Koene2, Faye L Norby2, Tony Wilsdon2, Alvaro Alonso2, David Siscovick2, Nona Sotoodehnia2, John Gottdiener2, Ervin R Fox2, Lin Y Chen2, Selcuk Adabag2, Aaron R Folsom2. 1. From the Cardiovascular Division (S.H.K., R.J.K., L.Y.C.) and Division of Epidemiology and Community Health (F.L.N., A.R.F.), University of Minnesota, Minneapolis; Department of Biostatistics (T.W.), Department of Epidemiology (D.S., N.S.), and Cardiovascular Health Research Unit, Department of Medicine (D.S., N.S.), University of Washington, Seattle; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.); University of Maryland Hospital, Baltimore (J.G.); Division of Cardiology, University of Mississippi, Jackson (E.R.F.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.). shkonety@umn.edu. 2. From the Cardiovascular Division (S.H.K., R.J.K., L.Y.C.) and Division of Epidemiology and Community Health (F.L.N., A.R.F.), University of Minnesota, Minneapolis; Department of Biostatistics (T.W.), Department of Epidemiology (D.S., N.S.), and Cardiovascular Health Research Unit, Department of Medicine (D.S., N.S.), University of Washington, Seattle; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.); University of Maryland Hospital, Baltimore (J.G.); Division of Cardiology, University of Mississippi, Jackson (E.R.F.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.).
Abstract
BACKGROUND: This study assessed the echocardiographic predictors of sudden cardiac death (SCD) within 2 population-based cohorts. METHODS AND RESULTS: Echocardiograms were obtained on 2383 participants (1993-1995) from the ARIC study (Atherosclerosis Risk in Communities; 100% black) and 5366 participants (1987-1989 and 1994-1995) from the CHS (Cardiovascular Health Study). The main outcome was physician-adjudicated SCD. We used Cox proportional-hazards models with incident coronary heart disease and heart failure as time-dependent covariates to assess the association between echocardiographic variables and SCD, adjusting for Framingham risk score variables, coronary heart disease, and renal function. Cohort-specific results were meta-analyzed. During a median follow-up of 7.3 and 13.1 years, 44 ARIC study participants and 275 CHS participants had SCD, respectively. In the meta-analyzed results, the adjusted hazard ratios (95% confidence intervals) for predictors of SCD were 3.07 (2.29-4.11) for reduced left ventricular ejection fraction; 1.85 (1.36-2.52) for mitral annular calcification; 1.64 (1.07-2.51) for mitral E/A >1.5, and 1.52 (1.14-2.02) for mitral E/A <0.7 (versus mitral E/A 0.7-1.5); 1.30 (1.15-1.48) per 1 SD increase in left ventricular mass; and 1.15 (1.02-1.30) per 1 SD increase in left atrial diameter. A receiver-operating characteristic model for prediction of SCD using Framingham risk score variables had a C statistic of 0.61 for ARIC study and 0.67 for CHS; the full multivariable model including all echocardiographic variables had a C statistic of 0.76 for ARIC study and 0.74 for CHS. CONCLUSIONS: In addition to reduced left ventricular ejection fraction, we identified other echocardiographic-derived variables predictive for SCD that provided incremental value compared with clinical risk factors.
BACKGROUND: This study assessed the echocardiographic predictors of sudden cardiac death (SCD) within 2 population-based cohorts. METHODS AND RESULTS: Echocardiograms were obtained on 2383 participants (1993-1995) from the ARIC study (Atherosclerosis Risk in Communities; 100% black) and 5366 participants (1987-1989 and 1994-1995) from the CHS (Cardiovascular Health Study). The main outcome was physician-adjudicated SCD. We used Cox proportional-hazards models with incident coronary heart disease and heart failure as time-dependent covariates to assess the association between echocardiographic variables and SCD, adjusting for Framingham risk score variables, coronary heart disease, and renal function. Cohort-specific results were meta-analyzed. During a median follow-up of 7.3 and 13.1 years, 44 ARIC study participants and 275 CHSparticipants had SCD, respectively. In the meta-analyzed results, the adjusted hazard ratios (95% confidence intervals) for predictors of SCD were 3.07 (2.29-4.11) for reduced left ventricular ejection fraction; 1.85 (1.36-2.52) for mitral annular calcification; 1.64 (1.07-2.51) for mitral E/A >1.5, and 1.52 (1.14-2.02) for mitral E/A <0.7 (versus mitral E/A 0.7-1.5); 1.30 (1.15-1.48) per 1 SD increase in left ventricular mass; and 1.15 (1.02-1.30) per 1 SD increase in left atrial diameter. A receiver-operating characteristic model for prediction of SCD using Framingham risk score variables had a C statistic of 0.61 for ARIC study and 0.67 for CHS; the full multivariable model including all echocardiographic variables had a C statistic of 0.76 for ARIC study and 0.74 for CHS. CONCLUSIONS: In addition to reduced left ventricular ejection fraction, we identified other echocardiographic-derived variables predictive for SCD that provided incremental value compared with clinical risk factors.
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