Prognosis of Individuals With Asymptomatic Left Ventricular Systolic Dysfunction in the Multi-Ethnic Study of Atherosclerosis (MESA)

Background-Limited data exist on the prevalence, associations, and prognosis of individuals with asymptomatic left ventricular systolic dysfunction (ALVSD), especially in populations without previous clinical cardiovascular disease (CVD). Methods and Results-Kaplan-Meier and Cox proportional hazard analyses were used to assess the association between ALVSD, defined as left ventricular ejection fraction < 50%, and adjudicated incident congestive heart failure (CHF), all-cause mortality, and CVD events. Of 5004 participants, 112 participants had CHF, 321 had a CVD event, and 278 died after 9 years of follow-up. The overall prevalence of ALVSD was 1.7%, with a higher prevalence in blacks (2.6%). ALVSD had a worse cardiovascular risk profile and was also associated with increased risk in unadjusted and adjusted models for incident CHF (HR [hazard ratio] [95% CI {confidence interval}]: 12.0 [7.04-20.3], P < 0.0001 and 8.69 [4.89-15.45], P < 0.001 respectively), CVD (HR [95% CI]: 3.32 [1.98-5.58], P < 0.001 and 2.21 [1.30-3.73], P = 0.003 respectively), and all-cause mortality (HR [95% CI]: 3.47 [2.03-5.94], P < 0.0001 and 2.00 [1.13-3.54], P = 0.017, respectively). A 10% decrement in left ventricular ejection fraction at baseline was associated with an increase in risk in unadjusted and adjusted models for clinical CHF (HR [95% CI]: 2.17 [1.82-2.63], P < 0.0001 and 2.13 [1.73-2.51], P < 0.001, respectively) and all-cause mortality (HR [95% CI]: 1.22 [1.05-1.41], P = 0.009 and 1.17 [1.00-1.36], P = 0.047, respectively). Among the subset of participants with ALVSD, the left ventricular mass index was particularly informative about risk for incident CHF (c-index = 0.74). Conclusions-ALVSD is uncommon in individuals without previous clinical CVD, but it is associated with high risk for CHF, CVD, and all-cause mortality. The left ventricular mass index had good discrimination for incident CHF in Multi-Ethnic Study of Atherosclerosis (MESA) participants with ALVSD. (Circulation. 2012;126:2713-2719.)