Comparing incidence of heart failure in individuals with enlarged cardiac chambers versus diabetes.

BACKGROUND

Opportunistic cardiac chamber volumetry derived from coronary artery calcium (CAC) scans using the AI-CVD platform predicts heart failure (HF) independent of conventional risk factors. Type 2 diabetes mellitus (T2DM), which classifies individuals as Stage A HF, is associated with chamber enlargement; however, the HF risk associated with chamber enlargement in the absence of T2DM has not been characterized.

METHODS

We analyzed left atrial (LA) and left ventricular (LV) volumes and mass, indexed to body surface area, using AI-CVD chamber volumetry of 7585 asymptomatic participants in the pooled cohort of Multi-Ethnic Study of Atherosclerosis (MESA) and Framingham Heart Study (FHS) second, and third generation (MESA & FHS; mean age 62.7 ± 14.6 years, 48.6 % male, 10.6 % with T2DM). Chambers were classified as enlarged (≥95th) or normal (<50th percentile). Cox regression and Kaplan-Meier analyses with log-rank tests were performed.

RESULTS

Over a median follow-up of 17.1 years, 438 HF events occurred. Individuals without T2DM, with enlarged chambers had HF incidence rates comparable to or higher than individuals with T2DM and normal chambers: LA volume 16.4 vs 8.7 (p = 0.001), LV volume 8.1 vs 8.9 (p = 0.66), and LV mass 10.1 vs 8.9 (p = 0.55) per 1000 person-years. After multivariable adjustment, compared with normal chambers, enlarged LA (HR 2.5[1.9-3.3]), LV (HR 3.5[2.3-5.4]), and LV mass (HR 3.2[2.2-4.9]) remained independently associated with HF in individuals without T2DM.

CONCLUSION

AI-derived cardiac chamber enlargement measured in CAC scans is associated with HF incidence in individuals without T2DM, supporting its potential utility in HF risk stratification.