Longitudinal Trajectories of Left Ventricular Myocardial Remodelling: Associations with Cardiovascular Risk Factors in the Multi-Ethnic Study of Atherosclerosis.

Background: Understanding the influence of cardiovascular risk factors on longitudinal cardiac remodelling requires three-dimensional analysis of longitudinal shape changes beyond scalar indicators such as mass and volumes. The aim of this study is to determine trajectories of cardiovascular risk factor-related remodelling in a large cohort imaging study.

Methods: We examined 2,521 participants (54% female, aged 60±9y) of the Multi-Ethnic Study of Atherosclerosis (MESA) at baseline and after 10 years. Myocardial remodelling was assessed by longitudinal left ventricular shape trajectories derived from cardiac magnetic resonance imaging using a statistical shape atlas. Penalized logistic regression was used to examine the associations between trajectory scores and cardiovascular risk factors, after adjustment for sex and age at baseline. Multivariate regression was used to determine independent shape changes associated with each risk factor.

Results: Between baseline and follow-up, there was a higher prevalence of hypertension (18.4%), antihypertensive medication usage (21.6%), statin usage, and treated diabetes mellitus (8.9%); all p < 0.05. Longitudinal shape trajectory scores had stronger associations with obesity, high blood pressure, hypertension medication and diabetes mellitus, than mass and volume changes (p<0.05). Multivariate regression showed independent longitudinal changes in wall thickening with obesity (13% increase), smoking (11% decrease), and high systolic blood pressure (5.6% increase), with distinct regional variations.

Conclusions: Trajectories of cardiovascular risk factor-related longitudinal remodelling can be examined using shape atlases. In addition to global changes, each risk factor is associated with a distinct regional remodelling of the myocardium.