TY - JOUR

T1 - Echocardiographic predictors of cardiovascular morbidity and mortality in women from the general population

AU - Lundorff, Ingrid

AU - Modin, Daniel

AU - Mogelvang, Rasmus

AU - Godsk Jørgensen, Peter

AU - Schnohr, Peter

AU - Gislason, Gunnar

AU - Biering-Sørensen, Tor

N1 - Publisher Copyright: © 2020 Published on behalf of the European Society of Cardiology. All rights reserved.

PY - 2021

Y1 - 2021

N2 - Aims: Global longitudinal strain (GLS) is a strong predictor of adverse cardiovascular outcome in men. However, studies have indicated that GLS may not predict cardiovascular outcomes as effectively in women. The aim of this study was to identify echocardiographic predictors of cardiovascular morbidity and mortality in women from the general population. Methods and results: A total of 1245 women from the general population free of heart failure (HF) and atrial fibrillation had an echocardiographic examination performed including tissue Doppler imaging. In this subset, 747 women had images eligible for strain analysis. Endpoint was a composite of acute myocardial infarction, HF, and cardiovascular death. During follow-up (median 12.5 years), 162 women (13.0%) reached the composite outcome. These women had higher left ventricular (LV) mass index (LVMI), more LV hypertrophy, lower E/A, higher E/e′, larger LV dimensions, and longer deceleration time. LVMI and e′ remained as significant predictors of the composite outcome [LVMI: hazard ratio (HR) 1.10, 95% confidence interval (CI) 1.03-1.17, P = 0.004, per 5 g/m2 increase] (e′: HR 1.53, 95% CI 1.07-2.20, P = 0.020, per 1 cm/s decrease) after adjusting for age, hypertension, systolic blood pressure, diabetes mellitus, total cholesterol, smoking status, prevalent ischaemic heart disease, LV ejection fraction, E/e′, E, E/A, interventricular septum thickness in diastole, left ventricular posterior wall in diastole, a′, body surface area, and pro-brain natriuretic peptide. GLS was not an independent predictor of outcome after multivariable adjustment. Conclusion: The degree of LV hypertrophy assessed as LVMI and diastolic dysfunction evaluated by e′ are associated with adverse cardiovascular outcome in women from the general population.

AB - Aims: Global longitudinal strain (GLS) is a strong predictor of adverse cardiovascular outcome in men. However, studies have indicated that GLS may not predict cardiovascular outcomes as effectively in women. The aim of this study was to identify echocardiographic predictors of cardiovascular morbidity and mortality in women from the general population. Methods and results: A total of 1245 women from the general population free of heart failure (HF) and atrial fibrillation had an echocardiographic examination performed including tissue Doppler imaging. In this subset, 747 women had images eligible for strain analysis. Endpoint was a composite of acute myocardial infarction, HF, and cardiovascular death. During follow-up (median 12.5 years), 162 women (13.0%) reached the composite outcome. These women had higher left ventricular (LV) mass index (LVMI), more LV hypertrophy, lower E/A, higher E/e′, larger LV dimensions, and longer deceleration time. LVMI and e′ remained as significant predictors of the composite outcome [LVMI: hazard ratio (HR) 1.10, 95% confidence interval (CI) 1.03-1.17, P = 0.004, per 5 g/m2 increase] (e′: HR 1.53, 95% CI 1.07-2.20, P = 0.020, per 1 cm/s decrease) after adjusting for age, hypertension, systolic blood pressure, diabetes mellitus, total cholesterol, smoking status, prevalent ischaemic heart disease, LV ejection fraction, E/e′, E, E/A, interventricular septum thickness in diastole, left ventricular posterior wall in diastole, a′, body surface area, and pro-brain natriuretic peptide. GLS was not an independent predictor of outcome after multivariable adjustment. Conclusion: The degree of LV hypertrophy assessed as LVMI and diastolic dysfunction evaluated by e′ are associated with adverse cardiovascular outcome in women from the general population.

KW - Echocardiography

KW - General population

KW - Risk prediction

KW - Women

U2 - 10.1093/ehjci/jeaa167

DO - 10.1093/ehjci/jeaa167

M3 - Journal article

C2 - 32864697

AN - SCOPUS:85114306028

VL - 22

SP - 1026

EP - 1034

JO - European Heart Journal Cardiovascular Imaging

JF - European Heart Journal Cardiovascular Imaging

SN - 2047-2404

IS - 9

ER -