title: Cardiovascular outcome associations among cardiovascular magnetic resonance measures of arterial stiffness: the Dallas heart study.
abstract: BACKGROUND
  Cardiovascular magnetic resonance (CMR) has been validated for the noninvasive assessment of total arterial compliance and aortic stiffness, but their associations with cardiovascular outcomes is unknown. The purpose of this study was to evaluate associations of CMR measures of total arterial compliance and two CMR measures of aortic stiffness with respect to future cardiovascular events.
  
  
  METHODS
  The study consisted of 2122 Dallas Heart Study participants without cardiovascular disease who underwent CMR at 1.5 Tesla. Aortic stiffness was measured by CMR-derived ascending aortic distensibility and aortic arch pulse wave velocity. Total arterial compliance was calculated by dividing left ventricular stroke volume by pulse pressure. Participants were monitored for cardiovascular death, non-fatal cardiac events, and non-fatal extra-cardiac vascular events over 7.8 ± 1.5 years. Cox proportional hazards regression was used to assess for associations between CMR measures and cardiovascular events.
  
  
  RESULTS
  Age, systolic blood pressure, and resting heart rate were independently associated with changes in ascending aortic distensibility, arch pulse wave velocity, and total arterial compliance (all p < .0001). A total of 153 participants (6.9%) experienced a cardiovascular event. After adjusting for traditional risk factors, total arterial compliance was modestly associated with increased risk for composite events (HR 1.07 per 1SD, p = 0.03) while the association between ascending aortic distensibility and composite events trended towards significance (HR 1.18 per 1SD, p = 0.08). Total arterial compliance and aortic distensibility were independently associated with nonfatal cardiac events (HR 1.11 per 1SD, p = 0.001 and HR 1.45 per 1SD, p = 0.0005, respectively), but not with cardiovascular death or nonfatal extra-cardiac vascular events. Arch pulse wave velocity was independently associated with nonfatal extra-cardiac vascular events (HR 1.18 per 1SD, p = 0.04) but not with cardiovascular death or nonfatal cardiac events.
  
  
  CONCLUSIONS
  In a multiethnic population free of cardiovascular disease, CMR measures of arterial stiffness are associated with future cardiovascular events. Total arterial compliance and aortic distensibility may be stronger predictors of nonfatal cardiac events, while pulse wave velocity may be a stronger predictor of nonfatal extra-cardiac vascular events.
authors.affiliation: Departments of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8896, USA. Christopher.Maroules@phhs.org.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Maroules
authors.forename: Amit
authors.initials: A
authors.lastname: Khera
authors.forename: Colby
authors.initials: C
authors.lastname: Ayers
authors.forename: Akshay
authors.initials: A
authors.lastname: Goel
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Peshock
authors.forename: Suhny
authors.initials: S
authors.lastname: Abbara
authors.forename: Kevin S
authors.initials: KS
authors.lastname: King
mesh_terms: D000328:Adult; D000367:Age Factors; D001013:Aorta, Thoracic / Q000503:physiopathology*; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000208:ethnology / Q000401:mortality / Q000503:physiopathology; D003187:Compliance; D005260:Female; D006339:Heart Rate; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D063177:Pulse Wave Analysis; D012307:Risk Factors; D013318:Stroke Volume; D013781:Texas / Q000453:epidemiology; D013997:Time Factors; D059289:Vascular Stiffness; D016277:Ventricular Function, Left