title: Left Ventricular Structure and Risk of Cardiovascular Events: A Framingham Heart Study Cardiac Magnetic Resonance Study.
abstract: BACKGROUND
  Elevated left ventricular mass index (LVMI) and concentric left ventricular (LV) remodeling are related to adverse cardiovascular disease (CVD) events. The predictive utility of LV concentric remodeling and LV mass in the prediction of CVD events is not well characterized.
  
  
  RESULTS
  Framingham Heart Study Offspring Cohort members without prevalent CVD (n=1715, 50% men, aged 65±9 years) underwent cardiovascular magnetic resonance for LVMI and geometry (2002-2006) and were prospectively followed for incident CVD (myocardial infarction, coronary insufficiency, heart failure, stroke) or CVD death. Over 13 808 person-years of follow-up (median 8.4, range 0.0 to 10.5 years), 85 CVD events occurred. In multivariable-adjusted proportional hazards regression models, each 10-g/m(2) increment in LVMI and each 0.1 unit in relative wall thickness was associated with 33% and 59% increased risk for CVD, respectively (P=0.004 and P=0.009, respectively). The association between LV mass/LV end-diastolic volume and incident CVD was borderline significant (P=0.053). Multivariable-adjusted risk reclassification models showed a modest improvement in CVD risk prediction with the incorporation of cardiovascular magnetic resonance LVMI and measures of LV concentricity (C-statistic 0.71 [95% CI 0.65 to 0.78] for the model with traditional risk factors only, improved to 0.74 [95% CI 0.68 to 0.80] for the risk factor model additionally including LVMI and relative wall thickness).
  
  
  CONCLUSIONS
  Among adults free of prevalent CVD in the community, greater LVMI and LV concentric hypertrophy are associated with a marked increase in adverse incident CVD events. The potential benefit of aggressive primary prevention to modify LV mass and geometry in these adults requires further investigation.
authors.affiliation: Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (C.W.T., C.J.S., W.J.M., C.J.D.) Framingham Heart Study, Framingham, MA (C.W.T., P.N.G., M.L.C., D.L., C.J.D.).
authors.forename: Connie W
authors.initials: CW
authors.lastname: Tsao
authors.affiliation: Department of Exercise and Health Sciences, University of Massachusetts, Boston, MA (P.N.G.) National Heart, Lung and Blood Institute, Framingham, MA (P.N.G., D.L., C.J.D.) Framingham Heart Study, Framingham, MA (C.W.T., P.N.G., M.L.C., D.L., C.J.D.).
authors.forename: Philimon N
authors.initials: PN
authors.lastname: Gona
authors.affiliation: Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (C.W.T., C.J.S., W.J.M., C.J.D.).
authors.forename: Carol J
authors.initials: CJ
authors.lastname: Salton
authors.affiliation: Framingham Heart Study, Framingham, MA (C.W.T., P.N.G., M.L.C., D.L., C.J.D.).
authors.forename: Michael L
authors.initials: ML
authors.lastname: Chuang
authors.affiliation: National Heart, Lung and Blood Institute, Framingham, MA (P.N.G., D.L., C.J.D.) Framingham Heart Study, Framingham, MA (C.W.T., P.N.G., M.L.C., D.L., C.J.D.).
authors.forename: Daniel
authors.initials: D
authors.lastname: Levy
authors.affiliation: Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (C.W.T., C.J.S., W.J.M., C.J.D.) Division of Radiology, Beth Israel Deaconess Medical Center, Boston, MA (W.J.M.).
authors.forename: Warren J
authors.initials: WJ
authors.lastname: Manning
authors.affiliation: Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (C.W.T., C.J.S., W.J.M., C.J.D.) Cardiology Section, Department of Medicine, Boston Veteran's Administration Healthcare System, Boston, MA (C.J.D.) National Heart, Lung and Blood Institute, Framingham, MA (P.N.G., D.L., C.J.D.) Framingham Heart Study, Framingham, MA (C.W.T., P.N.G., M.L.C., D.L., C.J.D.).
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: O'Donnell
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000473:pathology*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D020257:Ventricular Remodeling
keywords: cardiovascular disease; cardiovascular magnetic resonance; epidemiology; left ventricular geometry; left ventricular mass