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BACKGROUND—The predictive value of ascending aortic distensibility (AAD) for mortality and hard cardiovascular disease (CVD) events is not fully established. OBJECTIVES—We sought to assess the utility of AAD to predict mortality and incident CVD events beyond conventional risk factors in the Multi-Ethnic Study of Atherosclerosis (MESA). METHODS—AAD was measured with magnetic resonance imaging at baseline in 3,675 MESA participants free of overt CVD. Cox proportional-hazards regression was used to evaluate risk of © 2014 Elsevier Inc. All rights reserved. Correspondence: Alban Redheuil, MD, PhD, Cardiovascular Imaging Department DICVRI, Cardiology Institute, La Pitié Salpêtrière (APHP) and Sorbonne Universités, Université Pierre et Marie Curie UPMC, INSERM UMR S1146, Laboratoire d’imagerie biomédicale, ICAN Imaging Core Lab, 91, boulevard de l’hôpital, 75013 Paris, France., Tel: +33 6 64 87 87 95, alban.redheuil@psl.aphp.fr. Disclosures: MESA Study Funding Source: NHLBI, contracts N01-HC-95159 through N01-HC-95169. No conflicts of interest. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access Author Manuscript J Am Coll Cardiol. Author manuscript; available in PMC 2015 December 23. Published in final edited form as: J Am Coll Cardiol. 2014 December 23; 64(24): 2619–2629. doi:10.1016/j.jacc.2014.09.060. N IH -P A A uhor M anscript N IH -P A A uhor M anscript N IH -P A A uhor M anscript death, heart failure (HF), and incident CVD in relation to AAD, CVD risk factors, indices of subclinical atherosclerosis, and Framingham risk score. RESULTS—There were 246 deaths and 171 hard CVD (myocardial infarction, resuscitated cardiac arrest, stroke and cardiovascular [CV] death) and 88 HF events over a median 8.5-year follow-up. Decreased AAD was associated with increased all-cause mortality with a hazard ratio (HR) for the first verus fifth quintile of AAD of 2.7 (p = 0.008) independent of age, sex, ethnicity, other CVD risk factors, and indices of subclinical atherosclerosis. Overall, subjects with lowest AAD had an independent 2-fold risk of hard CVD events. Decreased AAD was associated with CV events in low-to-intermediate CVD risk individuals with an HR for the first quintile of AAD of 5.3 (p = 0.03) as well as with incident HF but not after full adjustment. CONCLUSIONS—Decreased proximal aorta distensibility significantly predicts all-cause mortality and hard CV events among individuals without overt CVD. AAD may help refine risk stratification, especially among asymptomatic, low-to-intermediate risk individuals.

european heart journal

Proximal aortic distensibility is an independent predictor of all-cause mortality and incident cardiovascular events in the multi-ethnic study of atherosclerosis