title: Proximal aortic distensibility is an independent predictor of all-cause mortality and incident CV events: the MESA study.
abstract: BACKGROUND
  The predictive value of ascending aortic distensibility (AAD) for mortality and hard cardiovascular disease (CVD) events has not been fully established.
  
  
  OBJECTIVE
  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.
authors.affiliation: Sorbonne Universités, Université Pierre et Marie Curie UPMC, Laboratoire d'imagerie biomédicale INSERM UMR_S1146, Paris, France; Cardiovascular Imaging Department and ICAN Imaging Core Lab, La Pitié Salpêtrière, Paris, France. Electronic address: alban.redheuil@psl.aphp.fr.
authors.forename: Alban
authors.initials: A
authors.lastname: Redheuil
authors.affiliation: Office of Biostatistics Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland.
authors.forename: Colin O
authors.initials: CO
authors.lastname: Wu
authors.affiliation: Sorbonne Universités, Université Pierre et Marie Curie UPMC, Laboratoire d'imagerie biomédicale INSERM UMR_S1146, Paris, France.
authors.forename: Nadjia
authors.initials: N
authors.lastname: Kachenoura
authors.affiliation: Division of Cardiology and Radiology, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Ohyama
authors.affiliation: Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Raymond T
authors.initials: RT
authors.lastname: Yan
authors.affiliation: Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Alain G
authors.initials: AG
authors.lastname: Bertoni
authors.affiliation: Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Hundley
authors.affiliation: Division of Cardiology and Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Duprez
authors.affiliation: Division of Cardiology and Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota.
authors.forename: David R
authors.initials: DR
authors.lastname: Jacobs
authors.affiliation: Division of Cardiology, University of California San Diego, La Jolla, California.
authors.forename: Lori B
authors.initials: LB
authors.lastname: Daniels
authors.affiliation: University of California Los Angeles Research Center, Alhambra, California.
authors.forename: Christine
authors.initials: C
authors.lastname: Darwin
authors.affiliation: Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Maryland.
authors.forename: Christopher
authors.initials: C
authors.lastname: Sibley
authors.affiliation: Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Maryland.
authors.forename: David A
authors.initials: DA
authors.lastname: Bluemke
authors.affiliation: Division of Cardiology and Radiology, Johns Hopkins University, Baltimore, Maryland.
authors.forename: João A C
authors.initials: JAC
authors.lastname: Lima
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000473:pathology / Q000503:physiopathology; D058070:Asymptomatic Diseases / Q000453:epidemiology; D050197:Atherosclerosis / Q000175:diagnosis / Q000208:ethnology / Q000503:physiopathology; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control; D002423:Cause of Death; D005006:Ethnicity; D005260:Female; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D059289:Vascular Stiffness
keywords: aortic stiffness; cardiovascular risk; magnetic resonance imaging; mortality