Abstract
Background: Left ventricular (LV) dyssynchrony is a measure of myocardial dysfunction in heart failure patients. However, its significance as a marker of incipient myocardial dysfunction in response to cumulative risk burden among asymptomatic individuals is not known. Our objective was to evaluate the extent of LV dyssynchrony in relationship to longitudinal changes in cardiovascular risk in otherwise healthy middle age individuals. Methods & Results: We defined five distinct Framingham risk score (FRS, D’Agostino Circulation 2008) (excluding age) trajectories in the CARDIA cohort (n=4634) to estimate the pattern of cumulative cardiovascular risk exposure over 25 year. Standard deviation of time to peak systolic circumferential strain (SD-TPS) among 6 mid-ventricular segments using 2-dimensional speckle-tracking echocardiography determined the extent of LV dyssynchrony in 2718 participant (54.3% women). Using multivariate linear regression after adjustment for demographics and LV ejection fraction, we found that among women in comparison to the low-stablegroup (reference trajectory), increased burden of cardiovascular risk was associated with progressively higher values of SD-TPS; B-coefficients were 3.50msec (95%CI, 0.23 - 6.77, p=0.04) for the moderate-stable, 7.32msec (2.56 - 12.09, p=0.003) for the elevated-stable, 8.79msec (3.49 - 14.10, p=0.001) for the moderate-increasing, and 9.54msec (0.09 - 18.99, p=0.048) for the elevated-increasing groups. There was attenuation of parameter estimates after further adjustment for cumulative body-mass-index (BMI) with loss of statistical significance. These associations were not statistically significant in men. Conclusions: Women had higher values of subclinical LV dyssynchrony in response to incremental cumulative cardiovascular risk burden over 25 years. Such relationships were absent in men. Cumulative BMI was the strongest predictor of LV dyssynchrony.
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