Abstract 16624: Association of Subclinical Atherosclerosis and Echocardiographic Indices of Cardiac Remodeling: The Framingham Study

Abstract

Subclinical atherosclerosis, a marker of myocardial ischemia, may impact cardiac remodeling indices; yet this association has not been evaluated. We hypothesized that higher coronary artery calcium (CAC) burden is associated with alterations of cardiac remodeling in individuals free of congestive heart failure (CHF) and myocardial infarct (MI). We related CT-based CAC score to echocardiographic (echo) indices in 2,650 Framingham Study participants (mean age 52 yrs, 48% women; 39% had CAC>0). We examined the following echo indices (log-transformed dependent variables): left ventricular (LV) mass index (LVMi), LV ejection fraction (LVEF), E/e’, global longitudinal strain (GLS), left atrial ejection fraction (LAEF) and aortic root diameter (AoR). Using multivariable-adjusted generalized linear models to account for relatedness, we modeled CAC score (independent variable) as a log-transformed continuous [ln(CAC+1)] or categorical (0, 1-100, and ≥101) variable. Adjusting for standard risk factors, higher CAC burden was associated with higher LVMi, E/e’ and AoR, and with lower LAEF. Those with CAC score≥101 had lower LAEF and higher E/e’ and AoR compared to those with CAC=0 ( P <0.05 for all, Figure). We observed effect modification by sex and age (interaction P <0.05) for the association of CAC score with LAEF and with AoR, respectively. In stratified analysis, higher CAC values were associated with lower LAEF values only in women ( P <0.003), and with higher AoR in older participants (>median age of 58 yrs; P <0.007). Conclusions: Subclinical atherosclerosis is associated with cardiac remodeling indices, consistent with the potential adverse impact of subclinical ischemia on myocardial and aortic remodeling in individuals free of CHF and MI. The prognostic significance of these associations warrant evaluation in future studies.