Cardiac microstructural alterations measured by echocardiography identify sex-specific risk for heart failure

Alan Kwan, Emmanuella Demosthenes, Gerran Salto, David Ouyang, Trevor Nguyen, Chike C. Nwabuo, Eric Luong, Amy Hoang, Ewa Osypiuk, Plamen Stantchev, Elizabeth H. Kim, Pranoti Hiremath, Debiao Li, Ramachandran Vasan, Vanessa Xanthakis, Susan Cheng

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Objective Established preclinical imaging assessments of heart failure (HF) risk are based on macrostructural cardiac remodelling. Given that microstructural alterations may also influence HF risk, particularly in women, we examined associations between microstructural alterations and incident HF. Methods We studied N=2511 adult participants (mean age 65.7±8.8 years, 56% women) of the Framingham Offspring Study who were free of cardiovascular disease at baseline. We employed texture analysis of echocardiography to quantify microstructural alteration, based on the high spectrum signal intensity coefficient (HS-SIC). We examined its relations to incident HF in sex-pooled and sex-specific Cox models accounting for traditional HF risk factors and macrostructural alterations. Results We observed 94 new HF events over 7.4±1.7 years. Individuals with higher HS-SIC had increased risk for incident HF (HR 1.67 per 1-SD in HS-SIC, 95% CI 1.31 to 2.13; p<0.0001). Adjusting for age and antihypertensive medication use, this association was significant in women (p=0.02) but not men (p=0.78). Adjusting for traditional risk factors (including body mass index, total/high-density lipoprotein cholesterol, blood pressure traits, diabetes and smoking) attenuated the association in women (HR 1.30, p=0.07), with mediation of HF risk by the HS-SIC seen for a majority of these risk factors. However, the HS-SIC association with HF in women remained significant after adjusting for relative wall thickness (representing macrostructure alteration) in addition to these risk factors (HR 1.47, p=0.02). Conclusions Cardiac microstructural alterations are associated with elevated risk for HF, particularly in women. Microstructural alteration may identify sex-specific pathways by which individuals progress from risk factors to clinical HF.

Original languageEnglish (US)
Pages (from-to)1800-1806
Number of pages7
Issue number22
StatePublished - Jun 9 2022
Externally publishedYes


  • Cardiomyopathies
  • Echocardiography
  • Heart Failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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