M-mode echocardiographic predictors at six- to seven-year incidence of coronary heart disease, stroke, congestive heart failure, and mortality in an elderly cohort (the Cardiovascular Health Study)

Previous studies have identified a number of echocardiographic variables th at predict cardiovascular disease (CVD) events and mortality, but have not focused on a large elderly cohort. The purpose of this study was to determi ne whether M-mode echocardiographic variables predicted ail-cause mortality , incident coronary heart disease (CHD), congestive heart failure (CHF), an d stroke in a large prospective, multicenter, population-based study. in th e Cardiovascular Health Study, a biracial cohort of 5,888 men and women (me an age 73 years) underwent 5-dimensional M-mode echocardiographic measureme nts of left ventricular (LV) internal dimensions, wail thickness, mass and geometry, as well as measurement of left atrial dimension and assessment fo r mitral annular calcium. Participants were followed for 6 to 7 years for i ncident events; analyses excluded subjects with prevalent disease. One or m ore echocardiographic measurements were independent predictors of air-cause mortality and incident CHD, CHF, and stroke. After adjustment for anthropo metric and traditional CVD risk factors, LV mass was significantly related to incident CHD, CHF, and stroke. The highest quartile of LV mass conferred a hazards ratio of 3.36, compared with the lowest quartile, for incident C HF. Furthermore, incident CHF-free survival was significantly lower for par ticipants with LV mass in the highest versus the 2 lowest quartiles (86% vs 97%, respectively, at 2,500 days). Eccentric and concentric LV hypertrophy , respectively, conferred adjusted hazards ratios, compared with normal LV geometry, of 2.05 and 1.61 for incident CHD, and 2.95 and 3.32 for incident CHF. Thus, in an elderly biracial population, selected 2-dimensional M-mod e echocardiographic measurements were important markers of subclinical dise ase and conferred independent prognostic information for incident CVD event s, especially CHF and CHD. (C) 2001 by Excerpta Medica Inc.