We studied left ventricular dimensions and calculated LVA-BSA in 6781 participants of the MESA study (mean age: was 62 ± 10 years, 53% females; 62% non-white) free from prior HF who underwent non-contrast cardiac CT to evaluate the coronary artery calcium score (CAC) at baseline and were followed up for a median of 10.2 years.
During follow up, 237 (3.5%) incident HF and 475 (7.0%) CVD events occurred. After adjustment for clinical variables and CAC, LVA-BSA was significantly associated with incident HF (hazard ratio [HR]: 1.10 per 100 mm2/m2, p < 0.001) and CVD events (HR: 1.07 per 100 mm2/m2, p < 0.001). The area under the ROC curve for the prediction of incident HF improved from 0.787 on a model including only risk factors to 0.798 when CAC was added (p = 0.02), and to 0.816 with the additional inclusion of LVA-BSA (p = 0.007). Similar improvements for the prediction of CVD events were noted.
In an ethnically diverse population of asymptomatic individuals free from baseline CVD or HF, the left ventricular area measured by non-contrast cardiac CT is a strong predictor of incident HF events beyond traditional risk factors and CAC score.