Beatrice von Jeinsen1, Meghan I Short2, Martin G Larson3, Vanessa Xanthakis4, David D McManus5, Emelia J Benjamin6, Gary F Mitchell7, Jayashri Aragam8, Susan Cheng9, Ramachandran S Vasan10. 1. Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts; Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany. 2. Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts. 3. Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts; Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts. 4. Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts; Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts; Sections of Preventive Medicine and Epidemiology and Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts. 5. Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical Center, Worcester, Massachusetts. 6. Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts; Sections of Preventive Medicine and Epidemiology and Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts; Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts. 7. Cardiovascular Engineering, Norwood, Massachusetts. 8. Harvard Medical School, Boston, Massachusetts; Cardiovascular Division, Veterans Administration Hospital, West Roxbury, Massachusetts. 9. Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California. 10. Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts; Sections of Preventive Medicine and Epidemiology and Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts; Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts. Electronic address: vasan@bu.edu.
Abstract
BACKGROUND: In recent decades, novel echocardiographic measures have constantly emerged. It is still unclear which echocardiographic measures have the most significant prognostic value in the general population. Accordingly, the aim of this study was to compare the prognostic value of a large panel of echocardiographic measures to identify the most promising measures. METHODS: A total of 1,497 Framingham study participants (mean age, 65 years; 55.4% women) who underwent echocardiographic measurements of left ventricular ejection fraction, left ventricular mass index, global longitudinal strain, global circumferential strain, mitral annular plane systolic excursion, mitral E/e' ratio, maximum and minimum left atrial (LA) volume index, LA emptying fraction, and left ventricular longitudinal synchrony were evaluated. These measures were related to the incidence of two composite outcomes: cardiovascular disease (CVD) or death and atrial fibrillation (AF) or congestive heart failure (CHF). RESULTS: On follow-up (mean, 8.3 years), there were 241 CVD events or deaths and 139 AF or CHF events. In multivariate-adjusted Cox models, higher LA emptying fraction was associated with a lower risk (hazard ratios per SD, 0.80 and 0.70 for CVD or death and AF or CHF, respectively; P ≤ .001 for both) while higher minimum LA volume index (hazard ratios per SD, 1.32 and 1.70 for CVD or death and AF or CHF, respectively; P ≤ .001 for both) and maximum LA volume index (hazard ratios per SD, 1.26 and 1.54 for CVD or death and AF or CHF, respectively; P ≤ .002 for both) were associated with a higher risk for both composite outcomes. CONCLUSIONS: In this community-based sample, LA volumes and function were the best echocardiographic predictors of clinical outcomes. Therefore, these values should be considered for inclusion in standard echocardiographic assessments for the purpose of risk stratification.
BACKGROUND: In recent decades, novel echocardiographic measures have constantly emerged. It is still unclear which echocardiographic measures have the most significant prognostic value in the general population. Accordingly, the aim of this study was to compare the prognostic value of a large panel of echocardiographic measures to identify the most promising measures. METHODS: A total of 1,497 Framingham study participants (mean age, 65 years; 55.4% women) who underwent echocardiographic measurements of left ventricular ejection fraction, left ventricular mass index, global longitudinal strain, global circumferential strain, mitral annular plane systolic excursion, mitral E/e' ratio, maximum and minimum left atrial (LA) volume index, LA emptying fraction, and left ventricular longitudinal synchrony were evaluated. These measures were related to the incidence of two composite outcomes: cardiovascular disease (CVD) or death and atrial fibrillation (AF) or congestive heart failure (CHF). RESULTS: On follow-up (mean, 8.3 years), there were 241 CVD events or deaths and 139 AF or CHF events. In multivariate-adjusted Cox models, higher LA emptying fraction was associated with a lower risk (hazard ratios per SD, 0.80 and 0.70 for CVD or death and AF or CHF, respectively; P ≤ .001 for both) while higher minimum LA volume index (hazard ratios per SD, 1.32 and 1.70 for CVD or death and AF or CHF, respectively; P ≤ .001 for both) and maximum LA volume index (hazard ratios per SD, 1.26 and 1.54 for CVD or death and AF or CHF, respectively; P ≤ .002 for both) were associated with a higher risk for both composite outcomes. CONCLUSIONS: In this community-based sample, LA volumes and function were the best echocardiographic predictors of clinical outcomes. Therefore, these values should be considered for inclusion in standard echocardiographic assessments for the purpose of risk stratification.
Authors: Roberto M Lang; Luigi P Badano; Victor Mor-Avi; Jonathan Afilalo; Anderson Armstrong; Laura Ernande; Frank A Flachskampf; Elyse Foster; Steven A Goldstein; Tatiana Kuznetsova; Patrizio Lancellotti; Denisa Muraru; Michael H Picard; Ernst R Rietzschel; Lawrence Rudski; Kirk T Spencer; Wendy Tsang; Jens-Uwe Voigt Journal: Eur Heart J Cardiovasc Imaging Date: 2015-03 Impact factor: 6.875
Authors: Michael R Bristow; David P Kao; Khadijah K Breathett; Natasha L Altman; John Gorcsan; Edward A Gill; Brian D Lowes; Edward M Gilbert; Robert A Quaife; Douglas L Mann Journal: JACC Heart Fail Date: 2017-11 Impact factor: 12.035
Authors: Liza Thomas; Thomas H Marwick; Bogdan A Popescu; Erwan Donal; Luigi P Badano Journal: J Am Coll Cardiol Date: 2019-04-23 Impact factor: 24.094
Authors: Renate B Schnabel; Xiaoyan Yin; Philimon Gona; Martin G Larson; Alexa S Beiser; David D McManus; Christopher Newton-Cheh; Steven A Lubitz; Jared W Magnani; Patrick T Ellinor; Sudha Seshadri; Philip A Wolf; Ramachandran S Vasan; Emelia J Benjamin; Daniel Levy Journal: Lancet Date: 2015-05-07 Impact factor: 79.321
Authors: Bernhard M Kaess; Jian Rong; Martin G Larson; Naomi M Hamburg; Joseph A Vita; Susan Cheng; Jayashree Aragam; Daniel Levy; Emelia J Benjamin; Ramachandran S Vasan; Gary F Mitchell Journal: J Am Heart Assoc Date: 2016-03-25 Impact factor: 5.501
Authors: Susan Cheng; Elizabeth L McCabe; Martin G Larson; Allison A Merz; Ewa Osypiuk; Birgitta T Lehman; Plamen Stantchev; Jayashri Aragam; Scott D Solomon; Emelia J Benjamin; Ramachandran S Vasan Journal: J Am Heart Assoc Date: 2015-10-27 Impact factor: 5.501
Authors: Adriaan A Voors; Jean-François Tamby; John G Cleland; Michael Koren; Leslie B Forgosh; Dinesh Gupta; Lars H Lund; Albert Camacho; Ravi Karra; Henk P Swart; Pierpaolo Pellicori; Frank Wagner; Ray E Hershberger; Narayana Prasad; Robert Anderson; Anu Anto; Kaylyn Bell; Jay M Edelberg; Liang Fang; Marcus Henze; Cynthia Kelly; Gregory Kurio; Wanying Li; Kate Wells; Chun Yang; Sam L Teichman; Carlos L Del Rio; Scott D Solomon Journal: Eur J Heart Fail Date: 2020-07-10 Impact factor: 15.534
Authors: Ibrahim Musa Yola; Albin Oh; Gary F Mitchell; George O'Connor; Susan Cheng; Ramachandran S Vasan; Vanessa Xanthakis Journal: PLoS One Date: 2021-02-16 Impact factor: 3.240