Background
Methods
Lipid, lipoprotein, and other laboratory assays
CMR for evaluation of diffuse fibrosis
Risk score models
Risk scores*
|
Endpoint prediction
|
Risk factors included in model
‡
|
---|---|---|
Edinburgh (CHD)1
| 10 year CHD | Age, Gender, Smoker, Diabetes, LVH, SBP, Chol, HDL |
Edinburgh (CVD)1
| 10 year CVD | Age, Gender, Smoker, Diabetes, LVH, SBP, Chol, HDL |
Death (CHD)1
| 10 year death from CHD | Age, Gender, Smoker, Diabetes, LVH, SBP, Chol, HDL |
Death (CVD)1
| 10 year death from CVD | Age, Gender, Smoker, Diabetes, LVH, SBP, Chol, HDL |
Myocardial Infarction (MI)1
| 10 year MI | Age, Gender, Smoker, Diabetes, LVH, SBP, Chol, HDL |
Stroke1
| 10 year stroke | Age, Gender, Smoker, Diabetes, LVH, SBP, Chol, HDL |
Framingham (CVD)3
| 10 year CVD | Age, Gender, Smoker, SBP, Chol, HDL, HTN Med |
National Cholesterol Education Program (NCEP)4
| 10 year CHD | Age, Smoker, Diabetes, SBP, HDL, LDL |
British National Formulary (BNF)1
| 10 year CVD | Age, Gender, Smoker, Diabetes, LVH, SBP, Chol, HDL |
ASSIGN1
| 10 year CVD | Age, Gender, Smoker, Diabetes, SBP, Chol, HDL, Cigarettes, MI Fam |
PROCAM2
| 10 year CHD | Diabetes, SBP, HDL, LDL, Trig, Glucose, HTN Med |
Reynolds5
| 10 year CHD | Age, Gender, Smoker, Diabetes, SBP, Chol, HDL, CRP, Hemoglobin, MI Fam |
MESA6
| 5 year HF | Age, Gender, Smoker, BMI Grade, SBP, Heart Rate, Diabetic Status, BNP, LV Mass |
Atherosclerotic Cardiovascular Disease (ASCVD)7
| 10 year CVD | Age, Gender, Smoker, Diabetes, SBP, Chol, HDL |
Statistical analysis
Results
Demographics
|
Women (n = 625)
|
Men (n = 606)
|
p-value
|
---|---|---|---|
Age (yrs) | 67 ± 9 | 67 ± 9 | 0.94 |
Height (cm) | 160 ± 6.6 | 174 ± 7.5 | <0.001 |
Weight (lb) | 161 ± 36 | 188 ± 35 | <0.001 |
BMI (kg/m2) | 28 ± 6 | 28 ± 5 | 0.24 |
White/African/Chinese/Hispanic (%) | 54/23/11/12 | 50/22/12/16 | 0.13 |
Heart rate (beats/min) | 65.3 ± 9.5 | 63.8 ± 10 | 0.005 |
Systolic blood pressure (mm Hg) | 122 ± 20 | 121 ± 18 | 0.49 |
Diastolic blood pressure (mm Hg) | 65 ± 9 | 71 ± 9 | <0.001 |
Current smokers | 41 (6.6) | 43 (7.1) | <0.001 |
Hypertension | 343 (54.9) | 298 (49.2) | 0.045 |
Diabetes | 87 (13.9) | 98 (16.2) | 0.002 |
Metabolic syndrome‡
| 233 (37.3) | 182 (30) | 0.001 |
HDL cholesterol (mg/dl) | 60.2 ± 16.9 | 49.1 ± 13.1 | <0.001 |
LDL cholesterol (mg/dl) | 110.8 ± 31.2 | 100.6 ± 30.4 | <0.001 |
Total cholesterol (mg/dl) | 193.2 ± 34.6 | 171.5 ± 34 | <0.001 |
Triglycerides (mg/dl) | 111.8 ± 58.7 | 110 ± 69 | 0.78 |
eGFR (ml/min/1.73 m2) | 85 ± 21 | 85 ± 17 | 0.52 |
Framingham risk score | 0.06 ± 0.04 | 0.13 ± 0.07 | <0.001 |
Native (Pre-contrast) myocardial T1 (ms) | 986 ± 45 | 968 ± 38 | <0.001 |
Post-contrast myocardial T1 (ms)§
| 505 ± 41 | 535 ± 34 | <0.001 |
Hematocrit (%) | 38.4 ± 2.9 | 41.6 ± 3.5 | <0.001 |
Extracellular volume fraction (%)ǁ
| 28.1 ± 2.8 | 25.8 ± 2.9 | <0.001 |
Risk score
|
Women
|
Men
|
p-value
|
---|---|---|---|
Edinburgh (CHD) | 5.772 ( 4.275 ) | 12.786 ( 7.034 ) |
<0.001
|
- | 552/51/12 | 226/300/72 | -- |
Edinburgh (CVD) | 11.629 ( 8.233 ) | 19.339 ( 10.1 ) |
<0.001
|
- | 337/197/81 | 98/253/247 | -- |
Death (CHD) | 1.204 ( 1.936 ) | 3.455 ( 3.159 ) |
<0.001
|
- | 610/5/0 | 571/25/2 | -- |
Death (CVD) | 3.481 ( 5.027 ) | 6.398 ( 6.583 ) |
<0.001
|
- | 563/41/11 | 477/97/24 | -- |
MI | 1.819 ( 2.282 ) | 5.944 ( 4.34 ) |
<0.001
|
- | 605/10/0 | 512/80/6 | -- |
STROKE | 3.017 ( 3.553 ) | 3.614 ( 3.542 ) |
0.003
|
- | 590/20/5 | 565/29/4 | -- |
Framingham (CVD) | 10.696 ( 8.223 ) | 25.221 ( 13.78 ) |
<0.001
|
- | 378/167/72 | 62/184/356 | -- |
NCEP | 10.583 ( 6.144 ) | 11.088 ( 6.365 ) | 0.162 |
- | 349/212/50 | 328/210/55 | -- |
BNF | 8.789 ( 6.874 ) | 16.4 ( 9.959 ) |
<0.001
|
- | 446/134/35 | 150/300/148 | -- |
ASSIGN | 13.222 ( 30.631 ) | 88.814 ( 29.171 ) |
<0.001
|
- | 264/13/96 | 36/9/516 | -- |
PROCAM | 0.407 ( 0.608 ) | 0.476 ( 0.514 ) |
0.033
|
- | 613/0/0 | 599/0/0 | -- |
Reynolds | 3.711 ( 4.837 ) | 12.377 ( 9.688 ) |
<0.001
|
- | 549/26/9 | 293/177/89 | -- |
MESA | 2.888 ( 6.518 ) | 2.854 ( 6.758 ) | 0.935 |
- | 480 / 14 / 13 | 471/19/10 | -- |
ASCVD | 10.116 ( 9.8 ) | 14.61 ( 8.895 ) |
<0.001
|
- | 258/111/49 | 138/159/82 | -- |
Risk score
|
β (msec/%) women/men
†
‡
|
CI (95%) women/men
†
|
p-value women/men
*†
|
---|---|---|---|
Edinburgh (CHD) | −0.343 / -0.288 | [ −1.116 to 0.43 ] / [ −0.668 to 0.093 ] | 0.383 / 0.138 |
Edinburgh (CVD) | −0.154 / -0.244 | [ −0.556 to 0.248 ] / [ −0.509 to 0.021 ] | 0.453 / 0.071 |
DEATH (CHD) | −0.011 / -0.701 | [ −1.718 to 1.697 ] / [ −1.549 to 0.147 ] | 0.99 / 0.105 |
DEATH (CVD) | 0.083 / -0.5 | [ −0.574 to 0.741 ] / [ −0.906 to −0.094 ] | 0.804 / 0.016
|
MI | −0.67 / -0.453 | [ −2.12 to 0.78 ] / [ −1.072 to 0.165 ] | 0.365 / 0.151 |
STROKE | −0.054 / -0.541 | [ −0.984 to 0.876 ] / [ −1.298 to 0.215 ] | 0.909 / 0.16 |
Framingham (CVD) | −0.119 / -0.206 | [ −0.522 to 0.284 ] / [ −0.398 to −0.013 ] | 0.562 / 0.037
|
NCEP | −0.045 / -0.058 | [ −0.587 to 0.496 ] / [ −0.484 to 0.368 ] | 0.869 / 0.789 |
BNF | −0.147 / -0.212 | [ −0.628 to 0.334 ] / [ −0.481 to 0.057 ] | 0.548 / 0.122 |
ASSIGN | −0.038 / -0.006 | [ −0.146 to 0.07 ] / [ −0.098 to 0.087 ] | 0.492 / 0.907 |
PROCAM | −2.578 / -2.131 | [ −8.041 to 2.885 ] / [ −7.328 to 3.067 ] | 0.354 / 0.421 |
Reynolds | −0.504 / -0.339 | [ −1.187 to 0.179 ] / [ −0.617 to −0.061 ] | 0.148 / 0.017
|
MESA | 0.126 / -0.391 | [ −0.437 to 0.689 ] / [ −0.832 to 0.05 ] | 0.661 / 0.082 |
ASCVD | −0.102 / -0.138 | [ −0.505 to 0.301 ] / [ −0.497 to 0.22 ] | 0.62 / 0.449 |
Risk score
|
β (msec/%) women/men
†
‡
|
CI (95%) women/men
†
|
p-value women/men
*†
|
---|---|---|---|
Edinburgh (CHD) | −0.175 / -0.485 | [ −0.939 to 0.589 ] / [ −0.88 to −0.089 ] | 0.654 / 0.016
|
Edinburgh (CVD) | −0.169 / -0.412 | [ −0.566 to 0.229 ] / [ −0.687 to −0.136 ] | 0.405 / 0.003
|
DEATH (CHD) | −0.44/-1.275 | [ −2.126 to 1.246 ] / [ −2.156 to −0.395 ] | 0.608 / 0.005
|
DEATH (CVD) | −0.215 / -0.798 | [ −0.864 to 0.434 ] / [ −1.218 to −0.378 ] | 0.515 / <0.001
|
MI | −0.12 / -0.783 | [ −1.553 to 1.313 ] / [ −1.427 to −0.14 ] | 0.87 / 0.017
|
STROKE | −0.27 / -1.067 | [ −1.188 to 0.649 ] / [ −1.854 to −0.28 ] | 0.564 / 0.008
|
Framingham (CVD) | −0.173 / -0.342 | [ −0.572 to 0.225 ] / [ −0.542 to −0.142 ] | 0.393 / 0.001
|
NCEP | 0.123 / -0.362 | [ −0.414 to 0.659 ] / [ −0.807 to 0.083 ] | 0.654 / 0.111 |
BNF | −0.14 / -0.377 | [ −0.615 to 0.335 ] / [ −0.656 to −0.098 ] | 0.564 / 0.008
|
ASSIGN | −0.023 / 0.026 | [ −0.129 to 0.083 ] / [ −0.07 to 0.122 ] | 0.666 / 0.598 |
PROCAM | −0.058 / -2.441 | [ −5.48 to 5.365 ] / [ −7.861 to 2.979 ] | 0.983 / 0.377 |
Reynolds | −0.335 / -0.554 | [ −1.008 to 0.339 ] / [ −0.839 to −0.268 ] | 0.329 / <0.001
|
MESA | 0.004 / -0.716 | [ −0.562 to 0.57 ] / [ −1.241 to −0.191 ] | 0.99 / 0.008
|
ASCVD | −0.099 / -0.307 | [ −0.492 to 0.293 ] / [ −0.694 to 0.08 ] | 0.619 / 0.12 |
Risk score
|
β (msec/%) women/men
†
‡
|
CI (95%) women/men
†
|
p-value women/men
*†
|
---|---|---|---|
Edinburgh (CHD) | 0.248 / 0.118 | [ −0.588 to 1.085 ] / [ −0.318 to 0.553 ] | 0.56 / 0.596 |
Edinburgh (CVD) | 0.286 / 0.32 | [ −0.148 to 0.72 ] / [ 0.017 to 0.623 ] | 0.196 / 0.038
|
DEATH (CHD) | 0.618 / 0.611 | [ −1.229 to 2.464 ] / [ −0.359 to 1.582 ] | 0.511 / 0.216 |
DEATH (CVD) | 0.268 / 0.565 | [ −0.443 to 0.979 ] / [ 0.101 to 1.029 ] | 0.459 / 0.017
|
MI | 1.198 / 0.241 | [ −0.368 to 2.765 ] / [ −0.467 to 0.949 ] | 0.134 / 0.504 |
STROKE | 0.578 / 1.345 | [ −0.428 to 1.583 ] / [ 0.485 to 2.205 ] | 0.26 / 0.002
|
Framingham (CVD) | 0.374 / 0.284 | [ −0.061 to 0.809 ] / [ 0.062 to 0.505 ] | 0.092 / 0.012
|
NCEP | 0.457 / 0.12 | [ −0.128 to 1.041 ] / [ −0.366 to 0.606 ] | 0.126 / 0.628 |
BNF | 0.25 / 0.229 | [ −0.269 to 0.77 ] / [ −0.079 to 0.536 ] | 0.344 / 0.145 |
ASSIGN | −0.039 / -0.169 | [ −0.159 to 0.081 ] / [ −0.275 to −0.062 ] | 0.523 / 0.002
|
PROCAM | 5.3 / -3.063 | [ −0.604 to 11.204 ] / [ −9.027 to 2.9 ] | 0.078 / 0.313 |
Reynolds | 0.252 / 0.495 | [ −0.51 to 1.015 ] / [ 0.172 to 0.819 ] | 0.516 / 0.003
|
MESA | 0.238 / 0.398 | [ −0.357 to 0.833 ] / [ −0.112 to 0.908 ] | 0.433 / 0.126 |
ASCVD | 0.302 / 0.423 | [ −0.141 to 0.744 ] / [ 0.006 to 0.84 ] | 0.181 / 0.047
|
Risk score
|
β (msec/%) women/men
†
‡
|
CI (95%) women/men
†
|
p-value women/men
*†
|
---|---|---|---|
Edinburgh (CHD) | −0.00053 / 0.00001 | [ −0.00129 to 0.00023 ] / [ −0.00046 to 0.00047 ] | 0.168 / 0.980 |
Edinburgh (CVD) | −0.00006 / 0.00029 | [ −0.00045 to 0.00033 ] / [ −3e-05 to 0.00061 ] | 0.764 / 0.080 |
DEATH (CHD) | −0.00049 / 0.00049 | [ −0.00216 to 0.00118 ] / [ −0.00054 to 0.00152 ] | 0.566 / 0.350 |
DEATH (CVD) | −0.00019 / 0.0007 | [ −0.00083 to 0.00046 ] / [ 0.00021 to 0.00119 ] | 0.568 / 0.005
|
MI | 0.00031 / 0.00004 | [ −0.00111 to 0.00173 ] / [ −0.00071 to 8e-04 ] | 0.664 / 0.908 |
STROKE | −0.00024 / 0.00098 | [ −0.00115 to 0.00067 ] / [ 6e-05 to 0.00189 ] | 0.608 / 0.037
|
Framingham (CVD) | −0.00011 / 0.00032 | [ −5e-04 to 0.00028 ] / [ 8e-05 to 0.00055 ] | 0.579 / 0.008
|
NCEP | −0.00003 / -0.00025 | [ −0.00056 to 5e-04 ] / [ −0.00077 to 0.00027 ] | 0.924 / 0.348 |
BNF | −0.00027 / 0.00013 | [ −0.00074 to 2e-04 ] / [ −2e-04 to 0.00045 ] | 0.262 / 0.448 |
ASSIGN | −0.00007 / -0.00013 | [ −0.00018 to 4e-05 ] / [ −0.00024 to -2e-05 ] | 0.214 / 0.024
|
PROCAM | 0.00324 / -0.00428 | [ −0.0021 to 0.00858 ] / [ −0.01063 to 0.00208 ] | 0.234 / 0.187 |
Reynolds | −0.00016 / 0.00047 | [ −0.00085 to 0.00053 ] / [ 0.00014 to 8e-04 ] | 0.645 / 0.006
|
MESA | −0.00007 / 0.00067 | [ −0.00061 to 0.00047 ] / [ 0.00014 to 0.00121 ] | 0.799 / 0.013
|
ASCVD | −0.00002 / 0.00048 | [ −0.00044 to 4e-04 ] / [ 3e-05 to 0.00093 ] | 0.914 / 0.035
|
Risk score
|
β (msec/%) women/men
†
‡
|
CI (95%) women/men
†
|
p-value women/men
*†
|
---|---|---|---|
Edinburgh (CHD) | −0.072 / -0.012 | [ −0.142 to −0.002 ] / [ −0.059 to 0.035 ] |
0.043 / 0.612 |
Edinburgh (CVD) | −0.013 / 0.014 | [ −0.051 to 0.025 ] / [ −0.019 to 0.047 ] | 0.497 / 0.397 |
DEATH (CHD) | −0.035 / 0.013 | [ −0.2 to 0.131 ] / [ −0.09 to 0.116 ] | 0.68 / 0.806 |
DEATH (CVD) | 0.004 / 0.056 | [ −0.053 to 0.062 ] / [ 0.007 to 0.105 ] | 0.88 / 0.025
|
MI | −0.05 / -0.023 | [ −0.199 to 0.098 ] / [ −0.097 to 0.05 ] | 0.506 / 0.532 |
STROKE | −0.012 / 0.086 | [ −0.106 to 0.082 ] / [ −0.007 to 0.178 ] | 0.805 / 0.069 |
Framingham (CVD) | −0.01 / 0.022 | [ −0.051 to 0.031 ] / [ −0.002 to 0.046 ] | 0.618 / 0.071 |
NCEP | 0.003 / -0.035 | [ −0.047 to 0.052 ] / [ −0.087 to 0.017 ] | 0.921 / 0.184 |
BNF | −0.033 / 0.005 | [ −0.079 to 0.012 ] / [ −0.028 to 0.038 ] | 0.151 / 0.777 |
ASSIGN | −0.007 / -0.016 | [ −0.018 to 0.003 ] / [ −0.027 to −0.005 ] | 0.177 / 0.003
|
PROCAM | −0.033 / -0.328 | [ −0.538 to 0.471 ] / [ −0.906 to 0.25 ] | 0.897 / 0.264 |
Reynolds | −0.083 / 0.041 | [ −0.165 to −0.002 ] / [ 0.009 to 0.073 ] |
0.044 / 0.013
|
MESA | −0.005 / 0.154 | [ −0.051 to 0.04 ] / [ 0.088 to 0.22 ] | 0.817 / <0.001
|
ASCVD | 0.01 / 0.001 | [ −0.026 to 0.047 ] / [ −0.04 to 0.042 ] | 0.579 / 0.957 |
Risk model
|
CMR index
|
β1
|
CI 1 (95%)
|
p-value
|
β2
|
CI 2 (95%)
|
p-value
|
---|---|---|---|---|---|---|---|
ASCVD | Native T1* | 0.941 | [ −0.266 to 2.148 ] | 0.123 | 0.398 | [ −0.033 to 0.830 ] | 0.070 |
Reynolds | Post T1 (12 min) | −0.241 | [ −0.721 to 0.239 ] | 0.322 | −0.419 | [ −0.838 to −0.001 ] |
0.050
|
Reynolds | Post T1 (25 min) | −0.498 | [ −0.879 to −0.116 ] |
0.011
| −0.807 | [ −1.829 to 0.214 ] | 0.113 |
MESA | Post T1 (25 min) | −1.152 | [ −2.012 to −0.292 ] |
0.009
| −0.504 | [ −1.590 to 0.582 ] | 0.360 |