Echocardiographic determinants of clinical outcome in subjects with coronary artery disease (the Framingham Heart Study)
Key result
Reduced fractional shortening in men and LV hypertrophy in women predict new cardiovascular events in CAD.
Why the study?
Do M-mode echocardiographic parameters predict new cardiovascular disease events in subjects with overt coronary artery disease?
Population
332 subjects (185 men and 147 women) with overt coronary artery disease from the Framingham Heart Study
Design
Cohort
Follow-up
mean 3.90 years
Authors
Discussion
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Implication
M-mode parameters may aid sex-specific prognostication in CAD; hypothesis-generating and should not yet change practice.
Key Points
- To determine whether M-mode echocardiographic measures of left ventricular structure and function predict future cardiovascular events in individuals with overt coronary artery disease.
- Prospective cohort study analyzing 185 men and 147 women with coronary artery disease from the Framingham Heart Study followed for a mean of 3.90 years.
- Participants underwent baseline M-mode echocardiography to measure left ventricular (LV) mass, fractional shortening, wall thickness, and chamber dimensions.
- Age-adjusted proportional hazards regression models assessed associations between echocardiographic parameters and incident cardiovascular disease events.
- New cardiovascular events occurred in 60 men (32%) and 58 women (39%) during follow-up.
- In men, significant predictors of events included LV mass/height (RR = 1.25 per 50 g/m increment, 95% CI 1.01 to 1.55), reduced fractional shortening (RR = 1.91, 95% CI 1.11 to 3.31), and reduced fractional shortening combined with LV dilatation (RR = 2.13, 95% CI 1.13 to 4.02).
- In women, cardiovascular risk was significantly elevated by LV hypertrophy (RR = 2.30, 95% CI 1.29 to 4.12), high LV wall thickness (RR = 3.36, 95% CI 1.18 to 9.55), high LV end-systolic diameter (RR = 2.59, 95% CI 1.45 to 4.62), and combined low fractional shortening and dilatation (RR = 3.25, 95% CI 1.28 to 8.25).
Study Design
Type
Cohort (n=332)
Structured PICO
Do M-mode echocardiographic parameters predict new cardiovascular disease events in subjects with overt coronary artery disease?
P
Population
332 subjects (185 men, 147 women) with overt coronary artery disease who underwent M-mode echocardiography, followed for a mean of 3.90 years.
E
Exposure
M-mode echocardiography parameters (including LV mass, LV dimensions, fractional shortening, LV dilatation, and LV hypertrophy)
O
Outcome
New cardiovascular disease events (composite of coronary disease, stroke, transient ischemic attack, claudication, heart failure and deaths from cardiovascular disease)composite
Main Result
Relative Risk: 1.91 (95% CI 1.11–3.31)
M-mode echocardiography provides significant prognostic value for predicting new cardiovascular events in patients with established coronary artery disease.
Cite This Study
Galderisi et al. (1992) conducted a cohort in coronary artery disease (n=332). Abnormal echocardiographic parameters (e.g., reduced fractional shortening, LV hypertrophy) vs. Normal echocardiographic parameters was evaluated on New cardiovascular disease events (coronary disease, stroke, transient ischemic attack, claudication, heart failure and deaths from cardiovascular disease) (RR 1.91, 95% CI 1.11 to 3.31). In subjects with coronary artery disease, reduced fractional shortening in men (RR 1.91; 95% CI 1.11-3.31) and LV hypertrophy in women (RR 2.30; 95% CI 1.29-4.12) predicted new cardiovascular events.