title: Association of subclinical atherosclerosis using carotid intima-media thickness, carotid plaque, and coronary calcium score with left ventricular dyssynchrony: the multi-ethnic Study of Atherosclerosis.
abstract: BACKGROUND
  The role of atherosclerosis in the progression of global left ventricular dysfunction and cardiovascular events has been well recognized. Left ventricular (LV) dyssynchrony is a measure of regional myocardial dysfunction. Our objective was to investigate the relationship of subclinical atherosclerosis with mechanical LV dyssynchrony in a population-based asymptomatic multi-ethnic cohort.
  
  
  RESULTS
  Participants of the Multi-Ethnic Study of Atherosclerosis (MESA) at exam 5 were evaluated using 1.5T cardiac magnetic resonance (CMR) imaging, carotid ultrasound (n = 2062) for common carotid artery (CCA) and internal carotid artery (ICA) intima-media thickness (IMT), and cardiac computed tomography (n = 2039) for coronary artery calcium (CAC) assessment (Agatston method). Dyssynchrony indices were defined as the standard deviation of time to peak systolic circumferential strain (SD-TPS) and the difference between maximum and minimum (max-min) time to peak strain using harmonic phase imaging in 12 segments (3-slices × 4 segments). Multivariable regression analyses were performed to assess associations after adjusting for participant demographics, cardiovascular risk factors, LV mass, and ejection fraction. In multivariable analyses, SD-TPS was significantly related to measures of atherosclerosis, including CCA-IMT (8.7 ms/mm change in IMT, p = 0.020), ICA-IMT (19.2 ms/mm change in IMT, p < 0.001), carotid plaque score (1.2 ms/unit change in score, p < 0.001), and log transformed CAC+1 (0.66 ms/unit log-CAC+1, p = 0.018). These findings were consistent with other parameter of LV dyssynchrony i.e. max-min.
  
  
  CONCLUSIONS
  In the MESA cohort, measures of atherosclerosis are associated with parameters of subclinical LV dyssynchrony in the absence of clinical coronary event and left-bundle-branch block.
authors: Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA.
authors: Ravi K
authors: RK
authors: Sharma
authors: Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA.
authors: Sirisha
authors: S
authors: Donekal
authors: Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA.
authors: Boaz D
authors: BD
authors: Rosen
authors: Division of Cardiology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
authors: Matthew C
authors: MC
authors: Tattersall
authors: Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA.
authors: Gustavo J
authors: GJ
authors: Volpe
authors: Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA.
authors: Bharath
authors: B
authors: Ambale-Venkatesh
authors: Centers for Prevention and Wellness, Baptist Health South Florida, Miami, FL, USA.
authors: Khurram
authors: K
authors: Nasir
authors: Office of Biostatistics Research, National Heart Lung and Blood Institute, Bethesda, MD, USA.
authors: Colin O
authors: CO
authors: Wu
authors: Department of Radiology, Tufts Medical Center, Boston, MA, USA.
authors: Joseph F
authors: JF
authors: Polak
authors: Division of Cardiology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
authors: Claudia E
authors: CE
authors: Korcarz
authors: Division of Cardiology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
authors: James H
authors: JH
authors: Stein
authors: Division of Radiology, Northwestern University, Chicago, IL, USA.
authors: James
authors: J
authors: Carr
authors: Department of Medicine, University of California, Los Angeles, CA, USA.
authors: Karol E
authors: KE
authors: Watson
authors: Radiology and Imaging Sciences, National Institutes of Health (NIH), Bethesda, MD, USA; Department of Radiology, Johns Hopkins University, Baltimore, MD, USA.
authors: David A
authors: DA
authors: Bluemke
authors: Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA; Department of Radiology, Johns Hopkins University, Baltimore, MD, USA. Electronic address: jlima@jhmi.edu.
authors: João A C
authors: JA
authors: Lima
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000150:complications / Q000503:physiopathology*; D002037:Bundle-Branch Block; D002114:Calcinosis / Q000503:physiopathology*; D002118:Calcium / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000150:complications; D002339:Carotid Arteries / Q000473:pathology*; D017536:Carotid Artery, Common / Q000473:pathology*; D059168:Carotid Intima-Media Thickness; D005260:Female; D005682:Gadolinium / Q000737:chemistry; D005919:Glomerular Filtration Rate; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009206:Myocardium / Q000473:pathology; D058226:Plaque, Atherosclerotic / Q000150:complications / Q000473:pathology*; D011446:Prospective Studies; D012307:Risk Factors; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000473:pathology*
chemical_list: D005682:Gadolinium; D002118:Calcium
keywords: Atherosclerosis; Carotid IMT; Coronary calcium score; Left ventricular dyssynchrony