Association of subclinical atherosclerosis with echocardiographic indices of cardiac remodeling: The Framingham Study

Background It is well established that coronary artery disease progresses along with myocardial disease. However, data on the association between coronary artery calcium (CAC) and echocardiographic variables are lacking. Methods and results Among 2,650 Framingham Study participants (mean age 51 yrs, 48% women; 40% with CAC>0), we related CT-based CAC score to left ventricular (LV) mass index (LVMi), LV ejection fraction (LVEF), E/e', global longitudinal strain (GLS), left atrial emptying fraction (LAEF), and aortic root diameter (AoR), using multivariable-adjusted generalized linear models. CAC score (independent variable) was used as log-transformed continuous [ln (CAC+1)] and as a categorical (0, 1-100, and >= 101) variable. Adjusting for standard risk factors, higher CAC score was associated with higher LVMi and AoR (beta(LVMI) per 1-SD increase 0.012, beta(AoR) 0.008; P<0.05, for both). Participants with 1 <= CAC <= 100 and those with CAC >= 101 had higher AoR (beta(AoR) 0.013 and 0.020, respectively, P = 0.01) than those with CAC = 0. CAC score was not significantly associated with LVEF, E/e', GLS or LAEF. Age modified the association of CAC score with AoR; higher CAC scores were associated with larger AoR more strongly in older (> 58 years; beta(AoR)0.0042;P<0.007) than in younger (<= 58 years) participants (beta(AoR)0.0027;P< 0.03). Conclusions We observed that subclinical atherosclerosis was associated with ventricular and aortic remodeling. The prognostic significance of these associations warrants evaluation in additional mechanistic studies.