title: Prevalence and Correlates of Myocardial Scar in a US Cohort.
abstract: OBJECTIVE
  Myocardial scarring leads to cardiac dysfunction and poor prognosis. The prevalence of and factors associated with unrecognized myocardial infarction and scar have not been previously defined using contemporary methods in a multiethnic US population.
  
  
  OBJECTIVE
  To determine prevalence of and factors associated with myocardial scar in middle- and older-aged individuals in the United States.
  
  
  METHODS
  The Multi-Ethnic Study of Atherosclerosis (MESA) study is a population-based cohort in the United States. Participants were aged 45 through 84 years and free of clinical cardiovascular disease (CVD) at baseline in 2000-2002. In the 10th year examination (2010-2012), 1840 participants underwent cardiac magnetic resonance (CMR) imaging with gadolinium to detect myocardial scar. Cardiovascular disease risk factors and coronary artery calcium (CAC) scores were measured at baseline and year 10. Logistic regression models were used to estimate adjusted odds ratios (ORs) for myocardial scar.
  
  
  METHODS
  Cardiovascular risk factors, CAC scores, left ventricle size and function, and carotid intima-media thickness.
  
  
  METHODS
  Myocardial scar detected by CMR imaging.
  
  
  RESULTS
  Of 1840 participants (mean [SD] age, 68 [9] years, 52% men), 146 (7.9%) had myocardial scars, of which 114 (78%) were undetected by electrocardiogram or by clinical adjudication. In adjusted models, age, male sex, body mass index, hypertension, and current smoking at baseline were associated with myocardial scar at year 10. The OR per 8.9-year increment was 1.61 (95% CI, 1.36-1.91; P < .001); for men vs women: OR, 5.76 (95% CI, 3.61-9.17; P < .001); per 4.8-SD body mass index: OR, 1.32 (95% CI, 1.09-1.61, P = .005); for hypertension: OR, 1.61 (95% CI, 1.12-2.30; P = .009); and for current vs never smokers: 2.00 (95% CI, 1.22-3.28; P = .006). Age-, sex-, and ethnicity-adjusted CAC scores at baseline were also associated with myocardial scar at year 10. Compared with a CAC score of 0, the OR for scores from 1 through 99 was 2.4 (95% CI, 1.5-3.9); from 100 through 399, 3.0 (95% CI, 1.7-5.1), and 400 or higher, 3.3 (95% CI, 1.7-6.1) (P ≤ .001). The CAC score significantly added to the association of myocardial scar with age, sex, race/ethnicity, and traditional CVD risk factors (C statistic, 0.81 with CAC vs 0.79 without CAC, P = .01).
  
  
  CONCLUSIONS
  The prevalence of myocardial scars in a US community-based multiethnic cohort was 7.9%, of which 78% were unrecognized by electrocardiography or clinical evaluation. Further studies are needed to understand the clinical consequences of these undetected scars.
authors.affiliation: Radiology and Imaging Sciences, National Institutes of Health Clinical Center, National Institute of Biomedical Imaging and Bioengineering, Bethesda, Maryland2Radiology and Radiological Science, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Evrim B
authors.initials: EB
authors.lastname: Turkbey
authors.affiliation: Radiology and Imaging Sciences, National Institutes of Health Clinical Center, National Institute of Biomedical Imaging and Bioengineering, Bethesda, Maryland.
authors.forename: Marcelo S
authors.initials: MS
authors.lastname: Nacif
authors.affiliation: Department of Biostatistics, University of Washington, Seattle.
authors.forename: Mengye
authors.initials: M
authors.lastname: Guo
authors.affiliation: Department of Biostatistics, University of Washington, Seattle.
authors.forename: Robyn L
authors.initials: RL
authors.lastname: McClelland
authors.affiliation: Department of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Patricia B R P
authors.initials: PB
authors.lastname: Teixeira
authors.affiliation: Patient-Centered Outcomes Research Institute, Washington, DC.
authors.forename: Diane E
authors.initials: DE
authors.lastname: Bild
authors.affiliation: Departments of Medicine and Epidemiology, Columbia University, New York, New York.
authors.forename: R Graham
authors.initials: RG
authors.lastname: Barr
authors.affiliation: Departments of Medicine and Epidemiology, Columbia University, New York, New York.
authors.forename: Steven
authors.initials: S
authors.lastname: Shea
authors.affiliation: Department of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Wendy
authors.initials: W
authors.lastname: Post
authors.affiliation: Division of Public Health Sciences, Wake Forest University Health Sciences, Winston-Salem, North Carolina.
authors.forename: Gregory
authors.initials: G
authors.lastname: Burke
authors.affiliation: Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Budoff
authors.affiliation: Division of Epidemiology and Community Health, University of Minnesota, Minneapolis.
authors.forename: Aaron R
authors.initials: AR
authors.lastname: Folsom
authors.affiliation: Radiology and Imaging Sciences, National Institutes of Health Clinical Center, National Institute of Biomedical Imaging and Bioengineering, Bethesda, Maryland.
authors.forename: Chia-Ying
authors.initials: CY
authors.lastname: Liu
authors.affiliation: Radiology and Radiological Science, Johns Hopkins University, Baltimore, Maryland4Department of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: João A
authors.initials: JA
authors.lastname: Lima
authors.affiliation: Radiology and Imaging Sciences, National Institutes of Health Clinical Center, National Institute of Biomedical Imaging and Bioengineering, Bethesda, Maryland2Radiology and Radiological Science, Johns Hopkins University, Baltimore, Maryland.
authors.forename: David A
authors.initials: DA
authors.lastname: Bluemke
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D044383:Black People; D015992:Body Mass Index; D002114:Calcinosis / Q000175:diagnosis / Q000453:epidemiology; D009202:Cardiomyopathies / Q000175:diagnosis / Q000453:epidemiology* / Q000208:ethnology / Q000209:etiology; D002318:Cardiovascular Diseases / Q000175:diagnosis; D002681:China / Q000208:ethnology; D002921:Cicatrix / Q000175:diagnosis / Q000453:epidemiology* / Q000208:ethnology / Q000209:etiology; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D005682:Gadolinium; D006630:Hispanic or Latino; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000453:epidemiology; D015995:Prevalence; D012044:Regression Analysis; D013997:Time Factors; D014481:United States; D044465:White People; D001741:Black or African American
chemical_list: D005682:Gadolinium