Normal findings on noninvasive cardiac assessment and the prediction of heart failure: The Multi-Ethnic Study of Atherosclerosis (MESA)

Background It is unknown if normal findings on noninvasive cardiac assessment are able to identify individuals who are low risk for developing heart failure (HF). Methods We examined if normal findings on the routine electrocardiogram (ECG) and cardiac magnetic resonance imaging (MRI) were able to identify individuals who are low risk for developing HF in 4986 (mean age = 62 ± 10 years; 52% women; 39% White; 13% Chinese-American; 26% Black; 22% Hispanic) participants from the Multi-Ethnic Study of Atherosclerosis who were free of clinically apparent HF at baseline. A normal ECG was defined as the absence of major abnormalities by Minnesota Code Classification, and a normal MRI was defined as absence of structural abnormalities and systolic dysfunction. Results There were 3988 (80%) participants with normal findings at baseline on both ECG and MRI, 894 (18%) who had either a normal ECG or normal MRI, and 104 (2%) who had abnormal findings on ECG and MRI. Over a median follow-up of 12.2 years, 177 (3.6%) HF events occurred. Normal ECG (HR = 0.41, 95%CI = 0.29, 0.56) and MRI (HR = 0.32, 95%CI = 0.23, 0.45) were each associated with lower risk of HF compared with abnormal, and their combination was associated with a lower HF risk (HR = 0.13, 95%CI = 0.08, 0.21) than either in isolation. Conclusion Normal findings on noninvasive cardiac assessment identify individuals in whom the risk of HF is low. Further studies are needed to explore the utility of this low-risk profile in HF prevention strategies.