title: Prognostic implications of left ventricular dyssynchrony for major adverse cardiovascular events in asymptomatic women and men: the Multi-Ethnic Study of Atherosclerosis.
abstract: BACKGROUND
  Left ventricular (LV) dyssynchrony is related to adverse outcomes in systolic heart failure, but its prognostic importance in asymptomatic population is not known. Our objective was to assess the prognostic implications of LV mechanical dyssynchrony in a large multiethnic population before the occurrence of global LV dysfunction.
  
  
  RESULTS
  A total of 1392 participants in the Multi-Ethnic Study of Atherosclerosis (MESA; mean age: 64.7 years; 46% were women) with cardiac magnetic resonance imaging at baseline were followed for a median duration of 8.3 years. Harmonic phase imaging analysis was used to derive systolic circumferential strain. Greater standard deviation of time to peak systolic strain (SD-TPS) indicates greater dyssynchrony. With SD-TPS as a continuous variable, Cox proportional hazards analysis was used to assess hazards ratio after adjusting for demographics, cardiovascular risk factors, LV mass-to-volume ratio, and ejection fraction. Using the 75th percentile of SD-TPS as a cutoff, Kaplan-Meier analysis was performed between 2 categorical groups for each gender. Higher values of dyssynchrony in women predicted major adverse cardiovascular events, defined as myocardial infarction, heart failure, stroke, and death (hazard ratio: 1.01 per 1-ms increment in SD-TPS, P=0.015), hard coronary events (hazard ratio: 1.05 per 1-ms increment in SD-TPS, P=0.026), and cerebrovascular events (hazard ratio: 1.03 per 1-ms increment in SD-TPS, P=0.013). In contrast, dyssynchrony in men was not predictive of events. Kaplan-Meier analyses in women revealed increased event occurrence in the higher dyssynchrony group, but this was not the case in men.
  
  
  CONCLUSIONS
  In an asymptomatic cohort, greater LV dyssynchrony determined by cardiac magnetic resonance imaging predicts adverse cardiovascular outcome in women but not in men.
  
  
  BACKGROUND
  http://clinicaltrials.gov. Unique identifier: NCT00005487.
authors.affiliation: Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland (R.K.S., G.V., B.D.R., B.A.V., S.D., D.A.B., J.L.).
authors.forename: Ravi K
authors.initials: RK
authors.lastname: Sharma
authors.affiliation: Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland (R.K.S., G.V., B.D.R., B.A.V., S.D., D.A.B., J.L.).
authors.forename: Gustavo
authors.initials: G
authors.lastname: Volpe
authors.affiliation: Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland (R.K.S., G.V., B.D.R., B.A.V., S.D., D.A.B., J.L.).
authors.forename: Boaz D
authors.initials: BD
authors.lastname: Rosen
authors.affiliation: Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland (R.K.S., G.V., B.D.R., B.A.V., S.D., D.A.B., J.L.).
authors.forename: Bharat
authors.initials: B
authors.lastname: Ambale-Venkatesh
authors.affiliation: Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland (R.K.S., G.V., B.D.R., B.A.V., S.D., D.A.B., J.L.).
authors.forename: Sirisha
authors.initials: S
authors.lastname: Donekal
authors.affiliation: Department of Medicine, Mount Sinai Hospital, New York City, New York (V.F.).
authors.forename: Veronica
authors.initials: V
authors.lastname: Fernandes
authors.affiliation: Office of Biostatistics Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland (C.O.W.).
authors.forename: Colin O
authors.initials: CO
authors.lastname: Wu
authors.affiliation: Department of Medicine, Vanderbilt University, Nashville, Tennessee (J.C.).
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Carr
authors.affiliation: Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland (R.K.S., G.V., B.D.R., B.A.V., S.D., D.A.B., J.L.) Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland (D.A.B., J.L.) Radiology and Imaging Sciences, National Institutes of Health (NIH), Bethesda, Maryland (D.A.B.).
authors.forename: David A
authors.initials: DA
authors.lastname: Bluemke
authors.affiliation: Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland (R.K.S., G.V., B.D.R., B.A.V., S.D., D.A.B., J.L.) Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland (D.A.B., J.L.).
authors.forename: João A C
authors.initials: JA
authors.lastname: Lima
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000503:physiopathology; D058070:Asymptomatic Diseases; D002318:Cardiovascular Diseases / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000453:epidemiology; D006352:Heart Ventricles / Q000503:physiopathology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012737:Sex Factors; D020521:Stroke / Q000453:epidemiology; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000503:physiopathology*
keywords: cardiac magnetic resonance imaging; cardiovascular events; left ventricular dyssynchrony; prognosis
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