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May 15, 2020PLoS ONEOpen Access

Association of subclinical atherosclerosis with echocardiographic indices of cardiac remodeling: The Framingham Study

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Why the study?

Coronary artery disease progresses alongside myocardial disease, but data evaluating the association between coronary artery calcium and echocardiographic variables were lacking.

Does higher coronary artery calcium (CAC) score correlate with worse echocardiographic indices of cardiac remodeling in adults without overt clinical CHD?

Population

2,650 Framingham Study participants

Comparison

CT-based CAC score analyzed continuously and categorically (0 vs 1-100 vs >=101)

Design

Cross-sectional observational study

Key result

Higher coronary artery calcium scores were significantly associated with higher left ventricular mass index (β=0.012) and aortic root diameter (β=0.008) in adults free of overt heart disease.

Authors

CCCecilia Castro‐DiehlRSRebecca J. SongGMGary F. Mitchell

Discussion

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Member takes

Overview

CAC-LVMi association in observational data should not change practice; leaves open whether atherosclerosis contributes to remodeling.

Key Points

  • This research aims to explore the relationship between subclinical atherosclerosis and various echocardiographic measures of cardiac remodeling.
  • Analyzed data from 2650 Framingham Study participants with a mean age of 51 years.
  • Utilized CT-based coronary artery calcium (CAC) scores as both continuous and categorical variables.
  • Employed multivariable-adjusted generalized linear models to assess associations with echocardiographic indices.
  • Higher CAC score was significantly associated with increased left ventricular mass index and aortic root diameter (P<0.05 for both).
  • Participants with CAC scores of 1-100 and ≥101 had larger aortic root diameters compared to those with CAC=0 (P=0.01).
  • Age modified the association, showing stronger correlations in older participants (>58 years) than younger ones (P<0.007).

Study Design

Type

Cross-Sectional (n=2,650)

Structured PICO

Does higher coronary artery calcium (CAC) score correlate with worse echocardiographic indices of cardiac remodeling in adults without overt clinical CHD?

P
Population
2,650 community-dwelling adults (mean age 51 years, 48% women) free of overt coronary heart disease and heart failure from the Framingham Heart Study.
E
Exposure
Coronary artery calcium (CAC) score assessed by chest CT (analyzed as log-transformed continuous and categorical variables: 0, 1-100, and ≥101)
C
Comparator
Participants with CAC = 0 or lower CAC scores
O
Outcome
Echocardiographic indices of cardiac remodeling: left ventricular mass index (LVMi), LV ejection fraction (LVEF), E/e', global longitudinal strain (GLS), left atrial emptying fraction (LAEF), and aortic root diameter (AoR)surrogate

Main Result

Effect estimate: β 0.012

p-value: p=0.048

Subclinical atherosclerosis, as measured by coronary artery calcium, is modestly associated with left ventricular and aortic root remodeling even in individuals without overt cardiovascular disease.

Limitations

  • Cross-sectional design limits causal inference.
  • Predominantly white, middle-class sample limits generalizability to other ethnicities.
  • Low prevalence of high CAC scores (>300) may have limited statistical power.
  • Small magnitude of effect sizes may lack clinical importance.
  • Missing left atrial emptying fraction (LAEF) data for Third Generation participants.
  • Cross-sectional design cannot infer causality
  • Predominantly white, largely middle-class, and middle-aged sample limits generalizability

Cite This Study

Castro‐Diehl et al. (2020) conducted a cross-sectional in Subclinical atherosclerosis (n=2,650). Coronary artery calcium (CAC) vs. CAC = 0 was evaluated on Left ventricular mass index (LVMi) (β 0.012, p=0.048). Higher coronary artery calcium scores were significantly associated with higher left ventricular mass index (β=0.012) and aortic root diameter (β=0.008) in adults free of overt heart disease.

synapsesocial.com/papers/6a3f16739dd34f95612e2175https://doi.org/10.1371/journal.pone.0233321
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Does Coronary Calcium Score Predict Future Cardiac Function? Association of Subclinical Atherosclerosis with Left Ventricular Systolic and Diastolic Dysfunction at MR Imaging in an Elderly Cohort2010 · 25 citations
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  4. 4Relationship Between Coronary Artery Calcification and Other Measures of Subclinical Cardiovascular Disease in Older Adults2002 · 100 citations
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