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Inter-Adventitial Diameters as Predictors of Congestive Heart Failure in MESA

This study examines the association between Inter-Adventitial Diameter (IAD) and cardiovascular outcomes, specifically congestive heart failure (CHF). The results suggest that IAD is predictive of incident CHF in individuals without cardiovascular disease at baseline. Further research is needed to clarify the underlying pathological processes.

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Inter-Adventitial Diameters as Predictors of Congestive Heart Failure in MESA

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  1. Inter-Adventitial Diameters as Predictors of Congestive Heart Failure in MESA(the Multi-Ethnic Study of Atherosclerosis) Joseph F. Polak MD, MPH, Quenna Wong BS, W. Craig Johnson MS, Wendy S. Post MD, Anita Harrington, MS, Daniel H. O'Leary, MD, N. David Yanez, PhD 1Department of Radiology, Tufts Medical Center, Tufts University School of Medicine, Boston MA; 2Collaborative Health Studies Coordinating Center University of Washington Collaborative Health Studies Coordinating Center, Seattle, WA;3 Johns Hopkins University Baltimore, MD; 4 Tufts University School of Medicine, Boston MA

  2. Response to Increased Blood Pressure • Pressure paces tension on the artery wall • The diameter of the artery increases

  3. Polak et al Atherosclerosis 2011;218:344

  4. Malek et al JAMA 1999; 282:2035

  5. Glagov Phenomenon • Preserve the artery lumen diameter as the artery wall thickens

  6. Polak et al Atherosclerosis 2011;218:344

  7. Background • Inter-Adventitial Diameter (IAD) is associated with Intima-Media Thickness (IMT) and Left Ventricular (LV) mass • Scientific question: Is IAD associated with cardiovascular outcomes ? • Outcome of interest is congestive heart failure (CHF) given the strong association between LV mass and CHF

  8. Methods • Incident CHF events were determined during an average follow-up of 6.1 years. • Multivariable Cox proportional hazards models were fitted with adjustment for age, sex, race/ethnicity, education, height, weight, HDL and total cholesterol, lipid-lowering medications, systolic blood pressure, hypertension medications, diabetes status, and current smoking status.

  9. Methods • Ultrasound examinations performed in 6623 participants (mean age 62.1 years) of the Multi-Ethnic Study of Atherosclerosis (MESA). • Multi-ethnic cohort of Caucasian, African-American, Hispanic and Chinese participants free of cardiovascular disease at baseline. • Right common carotid artery IAD was measured in regions free of plaque.

  10. Results • There were 145 adjudicated CHF events during the follow-up period. • After adjustment for all risk factors, IAD (in mm) was predictive of incident CHF [p = 0.011; hazard ratio (HR) 1.29 (1.06,1.58)].

  11. Results

  12. Results

  13. Results

  14. Results

  15. Results • Participants in the highest IAD quartile had a 74 percent higher relative hazard of CHF (HRR: 1.74 [95% C.I.: 1.21,2.51] compared to participants in the lower three IAD quartiles with similar CVD risk and adjustment profile.

  16. Conclusions • Inter-adventitial diameter of the common carotid artery is predictive of incident congestive heart failure in MESA, a cohort of individuals without cardiovascular disease at baseline. • The pathological processes at work need further clarification.

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