TY - JOUR
T1 - Risk factors for asymptomatic echocardiographic abnormalities that predict symptomatic heart failure
AU - Coller, Jennifer M.
AU - Gong, Fei Fei
AU - McGrady, Michele
AU - Shiel, Louise
AU - Liew, Danny
AU - Stewart, Simon
AU - Owen, Alice J.
AU - Krum, Henry
AU - Reid, Christopher M.
AU - Prior, David L.
AU - Campbell, Duncan J.
N1 - Funding Information:
This work was supported by Bupa Australia (Bupa Health Foundation), with subsequent support from the National Health and Medical Research Council of Australia (GTN0559010, GTN1044619, GTN1092642, GTN0395508 to D.J.C., GTN1045862, GTN1136372 to C.M.R., GTN1041796 to S.S., GTN0620241 to J.M.C., GNT0519456 to M.M.), the National Heart Foundation of Australia (G 07M 3198), the Diabetes Australia Research Trust (Y15G-CAMD), the University of Melbourne, St. Vincent's Hospital Melbourne, St. Vincent's Institute of Medical Research, and the Victorian Government's Operational Infrastructure Support Program. We thank all SCREEN-HF study participants and the study nurses, echocardiographers, and administrative staff for their invaluable contribution.
Funding Information:
Boffa was an employee of Bupa Australia. Liew received honoraria from Pfizer, Sanofi, Astra‐Zeneca, Abbott, Bayer, MSD, GSK, Novartis, and Nycomed. Stewart received unrestricted educational grants from Schering Plough and Boehringer Ingelheim and was Principal Investigator of the Novartis sponsored Valsartan Intensified Primary Care Reduction of Blood Pressure (VIPER‐BP) Study. Krum received support from Novartis, Bristol‐Myers Squibb, and Ardian/Medtronic. Prior received payments from Johnson & Johnson, Bayer, and Novartis for lectures. The remaining authors have no disclosures to report.
Funding Information:
This work was supported by Bupa Australia (Bupa Health Foundation), with subsequent support from the National Health and Medical Research Council of Australia (GTN0559010, GTN1044619, GTN1092642, GTN0395508 to D.J.C., GTN1045862, GTN1136372 to C.M.R., GTN1041796 to S.S., GTN0620241 to J.M.C., GNT0519456 to M.M.), the National Heart Foundation of Australia (G 07M 3198), the Diabetes Australia Research Trust (Y15G‐CAMD), the University of Melbourne, St. Vincent's Hospital Melbourne, St. Vincent's Institute of Medical Research, and the Victorian Government's Operational Infrastructure Support Program.
Publisher Copyright:
© 2021 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
PY - 2022/2
Y1 - 2022/2
N2 - Aims: Risk factors for asymptomatic echocardiographic abnormalities that predict symptomatic heart failure (HF) may provide insight into early mechanisms of HF pathogenesis. We examined risk factors associated with asymptomatic echocardiographic structural, systolic, and diastolic abnormalities, separately and in combination, and interactions between risk factors, in the prospective community-based SCReening Evaluation of the Evolution of New HF (SCREEN-HF) Study cohort of 3190 participants at increased risk of cardiovascular disease. Methods and results: Inclusion criteria were age ≥ 60 years with one or more of hypertension, diabetes, ischaemic heart disease, valvular heart disease, abnormal heart rhythm, cerebrovascular disease, or renal impairment. Exclusion criteria were known HF, ejection fraction < 50%, or >mild valve abnormality. Structural, systolic, and diastolic echocardiographic abnormalities were defined according to the Atherosclerosis Risk in Communities study criteria, and risk factors for asymptomatic structural, systolic, and diastolic abnormalities were identified using logistic regression analysis. In multivariable analysis, increased body mass index (BMI), non-steroidal anti-inflammatory drug therapy, and alcohol intake were risk factors for isolated structural abnormality, whereas male gender, increased heart rate, atrial fibrillation (AF), angiotensin-converting enzyme inhibitor therapy, and obstructive sleep apnoea were associated with a lower risk. Moreover, male gender, smoking, increased systolic blood pressure, and physical inactivity were risk factors for isolated systolic abnormality, whereas increased pulse pressure and antihypertensive therapy were associated with a lower risk. Furthermore, increased age, blood pressure, amino-terminal pro-B-type natriuretic peptide level, and warfarin therapy (associated with AF) were risk factors for isolated diastolic abnormality, whereas increased heart rate and triglyceride level (associated with BMI) were associated with a lower risk. The association of increased heart rate with lower risk of structural and diastolic abnormalities was independent of β-blocker therapy. Interactions between risk factors differed for structural, systolic, and diastolic abnormalities. Conclusions: The different risk factors for asymptomatic structural, systolic, and diastolic abnormalities that predict symptomatic HF, and the interactions between risk factors, illustrate how these structural, systolic, and diastolic abnormalities represent unique trajectories that lead to symptomatic HF. Improved understanding of these trajectories may assist in the design of HF prevention strategies.
AB - Aims: Risk factors for asymptomatic echocardiographic abnormalities that predict symptomatic heart failure (HF) may provide insight into early mechanisms of HF pathogenesis. We examined risk factors associated with asymptomatic echocardiographic structural, systolic, and diastolic abnormalities, separately and in combination, and interactions between risk factors, in the prospective community-based SCReening Evaluation of the Evolution of New HF (SCREEN-HF) Study cohort of 3190 participants at increased risk of cardiovascular disease. Methods and results: Inclusion criteria were age ≥ 60 years with one or more of hypertension, diabetes, ischaemic heart disease, valvular heart disease, abnormal heart rhythm, cerebrovascular disease, or renal impairment. Exclusion criteria were known HF, ejection fraction < 50%, or >mild valve abnormality. Structural, systolic, and diastolic echocardiographic abnormalities were defined according to the Atherosclerosis Risk in Communities study criteria, and risk factors for asymptomatic structural, systolic, and diastolic abnormalities were identified using logistic regression analysis. In multivariable analysis, increased body mass index (BMI), non-steroidal anti-inflammatory drug therapy, and alcohol intake were risk factors for isolated structural abnormality, whereas male gender, increased heart rate, atrial fibrillation (AF), angiotensin-converting enzyme inhibitor therapy, and obstructive sleep apnoea were associated with a lower risk. Moreover, male gender, smoking, increased systolic blood pressure, and physical inactivity were risk factors for isolated systolic abnormality, whereas increased pulse pressure and antihypertensive therapy were associated with a lower risk. Furthermore, increased age, blood pressure, amino-terminal pro-B-type natriuretic peptide level, and warfarin therapy (associated with AF) were risk factors for isolated diastolic abnormality, whereas increased heart rate and triglyceride level (associated with BMI) were associated with a lower risk. The association of increased heart rate with lower risk of structural and diastolic abnormalities was independent of β-blocker therapy. Interactions between risk factors differed for structural, systolic, and diastolic abnormalities. Conclusions: The different risk factors for asymptomatic structural, systolic, and diastolic abnormalities that predict symptomatic HF, and the interactions between risk factors, illustrate how these structural, systolic, and diastolic abnormalities represent unique trajectories that lead to symptomatic HF. Improved understanding of these trajectories may assist in the design of HF prevention strategies.
UR - http://www.scopus.com/inward/record.url?scp=85120317514&partnerID=8YFLogxK
U2 - 10.1002/ehf2.13695
DO - 10.1002/ehf2.13695
M3 - Article
C2 - 34850597
AN - SCOPUS:85120317514
SN - 2055-5822
VL - 9
SP - 196
EP - 212
JO - ESC Heart Failure
JF - ESC Heart Failure
IS - 1
ER -