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      Echocardiographic Predictors of Sudden Cardiac Death : The Atherosclerosis Risk in Communities Study and Cardiovascular Health Study

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          Abstract

          <div class="section"> <a class="named-anchor" id="S1"> <!-- named anchor --> </a> <h5 class="section-title" id="d8483011e257">Background</h5> <p id="P1">This study assessed the echocardiographic predictors of sudden cardiac death (SCD) within two population-based cohorts. </p> </div><div class="section"> <a class="named-anchor" id="S2"> <!-- named anchor --> </a> <h5 class="section-title" id="d8483011e262">Methods and Results</h5> <p id="P2">Echocardiograms were obtained on 2383 participants (1993–95) from the Atherosclerosis Risk in Communities (ARIC) Study (100% African-American) and 5366 participants (1987–89 and 1994–95) from the Cardiovascular Health Study (CHS). The main outcome was physician-adjudicated SCD. We used Cox proportional hazards models with incident coronary heart disease (CHD) and heart failure as time-dependent covariates to assess the association between echocardiographic variables and SCD, adjusting for Framingham risk score (FRS) variables, CHD, and renal function. Cohort-specific results were meta-analyzed. During a median follow-up of 7.3 years and 13.1 years, 44 ARIC Study and 275 CHS participants had SCD, respectively. In the meta-analyzed results, the adjusted hazard ratios (95% confidence intervals) for predictors of SCD were 3.07 (2.29–4.11) for reduced left ventricular ejection fraction (LVEF); 1.85 (1.36–2.52) for mitral annular calcification; 1.64 (1.07–2.51) for mitral E/A &gt;1.5 and 1.52 (1.14–2.02) for mitral E/A &lt;0.7 (vs mitral E/A 0.7–1.5); 1.30 (1.15–1.48) per one standard deviation (SD) increase in left ventricular mass; and 1.15 (1.02–1.30) per one SD increase in left atrial diameter. A receiver-operating characteristic model for prediction of SCD using FRS variables had a c-statistic of 0.61 for ARIC and 0.67 for CHS; the full multivariable model including all echocardiographic variables had a c-statistic of 0.76 for ARIC and 0.74 for CHS. </p> </div><div class="section"> <a class="named-anchor" id="S3"> <!-- named anchor --> </a> <h5 class="section-title" id="d8483011e267">Conclusions</h5> <p id="P3">In addition to reduced LVEF, we identified other echocardiographic-derived variables predictive for SCD that provided incremental value over clinical risk factors. </p> </div>

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          Most cited references 27

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          Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings.

          To determine the accuracy of echocardiographic left ventricular (LV) dimension and mass measurements for detection and quantification of LV hypertrophy, results of blindly read antemortem echocardiograms were compared with LV mass measurements made at necropsy in 55 patients. LV mass was calculated using M-mode LV measurements by Penn and American Society of Echocardiography (ASE) conventions and cube function and volume correction formulas in 52 patients. Penn-cube LV mass correlated closely with necropsy LV mass (r = 0.92, p less than 0.001) and overestimated it by only 6%; sensitivity in 18 patients with LV hypertrophy (necropsy LV mass more than 215 g) was 100% (18 of 18 patients) and specificity was 86% (29 of 34 patients). ASE-cube LV mass correlated similarly to necropsy LV mass (r = 0.90, p less than 0.001), but systematically overestimated it (by a mean of 25%); the overestimation could be corrected by the equation: LV mass = 0.80 (ASE-cube LV mass) + 0.6 g. Use of ASE measurements in the volume correction formula systematically underestimated necropsy LV mass (by a mean of 30%). In a subset of 9 patients, 3 of whom had technically inadequate M-mode echocardiograms, 2-dimensional echocardiographic (echo) LV mass by 2 methods was also significantly related to necropsy LV mass (r = 0.68, p less than 0.05 and r = 0.82, p less than 0.01). Among other indexes of LV anatomy, only measurement of myocardial cross-sectional area was acceptably accurate for quantitation of LV mass (r = 0.80, p less than 0.001) or diagnosis of LV hypertrophy (sensitivity = 72%, specificity = 94%).(ABSTRACT TRUNCATED AT 250 WORDS)
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            Irbesartan in patients with heart failure and preserved ejection fraction.

            Approximately 50% of patients with heart failure have a left ventricular ejection fraction of at least 45%, but no therapies have been shown to improve the outcome of these patients. Therefore, we studied the effects of irbesartan in patients with this syndrome. We enrolled 4128 patients who were at least 60 years of age and had New York Heart Association class II, III, or IV heart failure and an ejection fraction of at least 45% and randomly assigned them to receive 300 mg of irbesartan or placebo per day. The primary composite outcome was death from any cause or hospitalization for a cardiovascular cause (heart failure, myocardial infarction, unstable angina, arrhythmia, or stroke). Secondary outcomes included death from heart failure or hospitalization for heart failure, death from any cause and from cardiovascular causes, and quality of life. During a mean follow-up of 49.5 months, the primary outcome occurred in 742 patients in the irbesartan group and 763 in the placebo group. Primary event rates in the irbesartan and placebo groups were 100.4 and 105.4 per 1000 patient-years, respectively (hazard ratio, 0.95; 95% confidence interval [CI], 0.86 to 1.05; P=0.35). Overall rates of death were 52.6 and 52.3 per 1000 patient-years, respectively (hazard ratio, 1.00; 95% CI, 0.88 to 1.14; P=0.98). Rates of hospitalization for cardiovascular causes that contributed to the primary outcome were 70.6 and 74.3 per 1000 patient-years, respectively (hazard ratio, 0.95; 95% CI, 0.85 to 1.08; P=0.44). There were no significant differences in the other prespecified outcomes. Irbesartan did not improve the outcomes of patients with heart failure and a preserved left ventricular ejection fraction. (ClinicalTrials.gov number, NCT00095238.) 2008 Massachusetts Medical Society
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              M-mode echocardiographic predictors of six- to seven-year incidence of coronary heart disease, stroke, congestive heart failure, and mortality in an elderly cohort (the Cardiovascular Health Study).

              Previous studies have identified a number of echocardiographic variables that predict cardiovascular disease (CVD) events and mortality, but have not focused on a large elderly cohort. The purpose of this study was to determine whether M-mode echocardiographic variables predicted all-cause mortality, incident coronary heart disease (CHD), congestive heart failure (CHF), and stroke in a large prospective, multicenter, population-based study. In the Cardiovascular Health Study, a biracial cohort of 5,888 men and women (mean age 73 years) underwent 2-dimensional M-mode echocardiographic measurements of left ventricular (LV) internal dimensions, wall thickness, mass and geometry, as well as measurement of left atrial dimension and assessment for mitral annular calcium. Participants were followed for 6 to 7 years for incident events; analyses excluded subjects with prevalent disease. One or more echocardiographic measurements were independent predictors of all-cause mortality and incident CHD, CHF, and stroke. After adjustment for anthropometric and traditional CVD risk factors, LV mass was significantly related to incident CHD, CHF, and stroke. The highest quartile of LV mass conferred a hazards ratio of 3.36, compared with the lowest quartile, for incident CHF. Furthermore, incident CHF-free survival was significantly lower for participants with LV mass in the highest versus the 2 lowest quartiles (86% vs 97%, respectively, at 2,500 days). Eccentric and concentric LV hypertrophy, respectively, conferred adjusted hazards ratios, compared with normal LV geometry, of 2.05 and 1.61 for incident CHD, and 2.95 and 3.32 for incident CHF. Thus, in an elderly biracial population, selected 2-dimensional M-mode echocardiographic measurements were important markers of subclinical disease and conferred independent prognostic information for incident CVD events, especially CHF and CHD.
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                Author and article information

                Journal
                Circulation: Cardiovascular Imaging
                Circ Cardiovasc Imaging
                Ovid Technologies (Wolters Kluwer Health)
                1941-9651
                1942-0080
                August 2016
                August 2016
                : 9
                : 8
                Affiliations
                [1 ]From the Cardiovascular Division (S.H.K., R.J.K., L.Y.C.) and Division of Epidemiology and Community Health (F.L.N., A.R.F.), University of Minnesota, Minneapolis; Department of Biostatistics (T.W.), Department of Epidemiology (D.S., N.S.), and Cardiovascular Health Research Unit, Department of Medicine (D.S., N.S.), University of Washington, Seattle; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.); University of Maryland Hospital, Baltimore (J.G.);...
                Article
                10.1161/CIRCIMAGING.115.004431
                5010094
                27496550
                © 2016

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