Abstract 16064: Coronary Artery Calcification, Left Atrial, and Left Ventricular Size Measured From Non-contrast Cardiac CT Predict Incident Heart Failure Hospitalization in the General Population

Abstract

Objective: Non-contrast cardiac computed tomography (CT) is increasingly performed especially in the absence of known cardiac disease. We aimed to determine, whether CT-derived left atrial (LA), left ventricle (LV) size, and coronary artery calcification (CAC) are associated with future hospitalizations due to heart failure (HF). Methods: Subjects without known cardiac diseases from the population based Heinz Nixdorf Recall Study were followed for incident HF hospitalization. From non-contrast cardiac CT, LA and LV area were measured from axial images and indexed by body surface area. Cox regression analysis determined the association of each CT-measure with HF hospitalization in unadjusted and ASCVD-Score (atherosclerotic cardiovascular disease, pooled cohort risk equation) adjusted analysis. Hazard ratios (HR) and 95% confidence intervals are shown per standard deviation of LA/LV area and increase in log(CAC+1) by 1. Results: From 3944 subjects without known cardiac disease (59±8 years, 47% male, mean ASCVD-Score 11.3±10.8%), 31 subjects (0.8%) were hospitalized due to HF during 10.3±2.0 years of follow-up. LA index, LV index, and CAC-score were significantly associated with incident HF hospitalization in unadjusted analysis (LA: 3.24 [1.75-5.99], p=0.0002, LV: 5.65 [3.02-10.57], p<0.0001, CAC: 1.30 [1.12-1.51], p=0.0007). HRs remained significant for all three CT-measures after adjustment for ASCVD-Score (LA: 2.59 [1.36-4.94], p=0.004; LV: 4.19 [2.17-8.08], p<0.0001, CAC: 1.19 [1.01-1.40], p=0.042). Stratifying by age at baseline, association of LA and LV were stronger for younger subjects (<65 years: LA: 4.26 [1.91-9.49], p=0.0004; LV: 7.38 [3.23-16.88], p<0.0001; ≥65 years: LA: 1.40 [0.57-3.48], p=0.5; LV: 3.08 [1.13-8.36], p=0.03) while CAC-score was stronger in older subjects (<65 years: 1.07 [0.84-1.36], p=0.6; ≥65 years: 1.29 [1.01-1.65], p=0.041) in ASCVD-adjusted analysis. Conclusion: LA size, LV size, and CAC-score as measured from non-contrast cardiac CT are associated with incident HF hospitalization in the general population. Once cardiac CT is performed, quantification of LA and LV size may identify subjects at early and subclinical stages of HF that qualify for further cardiac workup, especially in younger age.