Abstract 13405: Cardiac Computed Tomography Variables for Prediction of New-Onset Heart Failure: Multi-Ethnic Study of Atherosclerosis

Introduction: Heart failure (HF) prediction models utilize clinical variables. The purpose of this study was to determine if addition of cardiac computed tomography (CT) variables could improve discrimination of HF prediction scores.

Methods: Participants of the Multi-Ethnic Study of Atherosclerosis (MESA), a cohort between 45 to 84 years old and free of clinical cardiovascular disease at baseline, with complete clinical data and cardiac CT were included to evaluate new-onset HF during the follow-up period. Cardiac CT variables analyzed included left ventricular size index (LVSi) and calcification of the coronary arteries (CAC), aortic valve (AVC), mitral valve (MVC), and thoracic aorta (TAC). We evaluated if CT variables improved the Pooled Cohort equations to Prevent HF (PCP-HF) score (an internally and externally validated model of 33,010 patients predicting 10-year risk of new-onset HF).

Results: Among 6,667 MESA participants (52.7% female), 426 events of new-onset HF occurred during the follow-up period. After the Cox model was adjusted for cardiac CT and PCP-HF score variables, CAC (HR 1.10; 95% CI 1.05-1.15; p<0.001), AVC (HR 1.08; 95% CI 1.03-1.13; p=0.002), MVC (HR 1.06; 95% CI 1.01-1.12; p=0.015), and LVSi (HR 1.14; 95% CI 1.10-1.18; p<0.001) were all significantly associated with new-onset HF. After using time-dependent ROC and stratifying by sex, AUC discrimination of new-onset HF with the PCP-HF score was improved by the inclusion of cardiac CT variables. In females, the AUC for 10-year risk of new-onset HF improved from 0.80 to 0.86 with the addition of cardiac CT variables. In males, the AUC for 10-year risk of new-onset HF improved from 0.77 to 0.84 with the addition of cardiac CT variables.

Conclusions: In addition to traditional clinical risk factors, cardiac CT variables provide anatomic risk factors that improve the prediction of new-onset HF. Coronary and valvular calcification may signal poorly controlled clinical risk factors that are often associated with HF. LVSi may reflect left ventricular remodeling associated with HF. More studies are needed to further elucidate the relationship between cardiac CT anatomic risk factors and HF.