Association between myocardial work indices and cardiovascular events according to hypertension in the general population

Author:

Olsen Flemming Javier123ORCID,Skaarup Kristoffer Grundtvig12ORCID,Lassen Mats Christian Højbjerg12ORCID,Johansen Niklas Dyrby123ORCID,Jensen Gorm Boje2,Schnohr Peter2,Marott Jacob Louis2ORCID,Søgaard Peter45,Gislason Gunnar15,Svendsen Jesper Hastrup56,Møgelvang Rasmus567,Aalen John Moene8,Smiseth Otto Armin8ORCID,Remme Espen Wattenberg89,Biering-Sørensen Tor123ORCID

Affiliation:

1. Department of Cardiology, Copenhagen University Hospital—Herlev and Gentofte , Gentofte Hospitalsvej 1 , Hellerup 2900, Denmark

2. The Copenhagen City Heart Study, Copenhagen University Hospital—Bispebjerg and Frederiksberg , Bispebjerg Bakke 23, Copenhagen 2400 , Denmark

3. Department of Biomedical Sciences, University of Copenhagen , Blegdamsvej 3B, Copenhagen 2200 , Denmark

4. Department of Cardiology, Copenhagen University Hospital—North Zealand , Dyrehavevej 29, Hilleroed 3400 , Denmark

5. Department of Clinical Medicine, University of Copenhagen , Blegdamsvej 3B, Copenhagen 2200 , Denmark

6. Department of Cardiology, Copenhagen University Hospital—Rigshospitalet , Blegdamsvej 9, Copenhagen 2100 , Denmark

7. Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark , Campusvej 55, Odense 5230 , Denmark

8. Institute for Surgical Research, Oslo University Hospital and University of Oslo, Rikshospitalet , Sognsvannsveien 20, Oslo 0372 , Norway

9. The Intervention Centre, Oslo University Hospital, Rikshospitalet , Sognsvannsveien 20, Oslo 0372 , Norway

Abstract

Abstract Aims Pressure-strain loop (PSL) analysis is a novel echocardiographic tool capable of assessing myocardial work non-invasively. In this study, we aim to evaluate the prognostic value of myocardial work indices in the general population. Methods and results This was a prospective community-based cohort study (n = 4466). PSL analyses were performed to acquire global work index (GWI), global constructive work (GCW), global wasted work, and global work efficiency (GWE). The endpoint was a composite of heart failure or cardiovascular death (HF/CVD). Survival analysis was applied. A total of 3932 participants were included in this analysis (median age: 58 years, 43% men). Of these, 124 (3%) experienced the outcome during a median follow-up period of 3.5 years [interquartile range (IQR): 2.6–4.4 years]. Hypertension significantly modified the association between all work indices and outcome (P for interaction < 0.05), such that work indices posed a higher risk of outcome in non-hypertensive than in hypertensive participants. After adjusting for Atherosclerosis Risk in Communities (ARIC)-HF risk variables, all work indices predicted outcome in non-hypertensive participants, but only GWI, GCW, and GWE predicted outcome in hypertensive participants [GWI: hazard ratio (HR) = 1.12 (1.07–1.16), per 100 mmHg% decrease; GCW: HR = 1.12 (1.08–1.17), per 100 mmHg% decrease; GWE: HR = 1.08 (1.04–1.12), per 1% decrease]. Only GWE significantly increased C-statistics when added to ARIC-HF risk variables in hypertensive participants (C-stat 0.865 vs. 0.877, P for increment = 0.003). Conclusion Hypertension modifies the association between myocardial work indices and HF/CVD in the general population. All work indices are associated with outcome in normotensive participants. GWI, GCW, and GWE are independently associated with outcome in hypertension, but only GWE improves risk prediction.

Funder

Metropolitan Region of Denmark

Danish Heart Foundation

Copenhagen University Hospital

Gentofte

Fru Asta Florida Boldings Mindelegat

Kong Christian den Tiendes Fond

Fondsbørsvekselerer Henry Hansen og Hustrus Hovedlegat

Lundbeck Foundation

Copenhagen University Hospital—Herlev and Gentofte

Novo Nordisk Foundation

Publisher

Oxford University Press (OUP)

Subject

Cardiology and Cardiovascular Medicine,Radiology, Nuclear Medicine and imaging,General Medicine

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