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Department of Medicine, Division of Cardiovascular Medicine

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Cardiology | Cardiovascular Diseases | Circulatory and Respiratory Physiology | Nutritional and Metabolic Diseases


BACKGROUND: It is well established that coronary artery disease progresses along with myocardial disease. However, data on the association between coronary artery calcium (CAC) and echocardiographic variables are lacking.

METHODS AND RESULTS: Among 2,650 Framingham Study participants (mean age 51 yrs, 48% women; 40% with CAC > 0), we related CT-based CAC score to left ventricular (LV) mass index (LVMi), LV ejection fraction (LVEF), E/e', global longitudinal strain (GLS), left atrial emptying fraction (LAEF), and aortic root diameter (AoR), using multivariable-adjusted generalized linear models. CAC score (independent variable) was used as log-transformed continuous [ln(CAC+1)] and as a categorical (0, 1-100, and > /=101) variable. Adjusting for standard risk factors, higher CAC score was associated with higher LVMi and AoR (betaLVMI per 1-SD increase 0.012, betaAoR 0.008; P < 0.05, for both). Participants with 1 < /=CAC < /=100 and those with CAC > /=101 had higher AoR (betaAoR 0.013 and 0.020, respectively, P = 0.01) than those with CAC = 0. CAC score was not significantly associated with LVEF, E/e', GLS or LAEF. Age modified the association of CAC score with AoR; higher CAC scores were associated with larger AoR more strongly in older ( > 58 years; betaAoR0.0042;P < 0.007) than in younger ( < /=58 years) participants (betaAoR0.0027;P < 0.03).

CONCLUSIONS: We observed that subclinical atherosclerosis was associated with ventricular and aortic remodeling. The prognostic significance of these associations warrants evaluation in additional mechanistic studies.


Coronary heart disease, Blood pressure, Atherosclerosis, Hypertension, Echocardiography, Lipids, Physical activity, Diabetes mellitus

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Copyright: © 2020 Castro-Diehl et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

DOI of Published Version



Castro-Diehl C, Song RJ, Mitchell GF, McManus D, Cheng S, Vasan RS, Xanthakis V. Association of subclinical atherosclerosis with echocardiographic indices of cardiac remodeling: The Framingham Study. PLoS One. 2020 May 15;15(5):e0233321. doi: 10.1371/journal.pone.0233321. PMID: 32413074; PMCID: PMC7228064. Link to article on publisher's site

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PloS one

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Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.