Comparing incidence of heart failure in individuals with enlarged cardiac chambers versus diabetes

Background: Opportunistic cardiac chamber volumetry derived from coronary artery calcium (CAC) scans using the AI-CVD platform predicts heart failure (HF) independent of conventional risk factors. Type 2 diabetes mellitus (T2DM), which classifies individuals as Stage A HF, is associated with chamber enlargement; however, the HF risk associated with chamber enlargement in the absence of T2DM has not been characterized. Methods: We analyzed left atrial (LA) and left ventricular (LV) volumes and mass, indexed to body surface area, using AI-CVD chamber volumetry of 7585 asymptomatic participants in the pooled cohort of Multi-Ethnic Study of Atherosclerosis (MESA) and Framingham Heart Study (FHS) second, and third generation (MESA & FHS; mean age 62.7 ± 14.6 years, 48.6 % male, 10.6 % with T2DM). Chambers were classified as enlarged (≥95th) or normal (<50th percentile). Cox regression and Kaplan–Meier analyses with log-rank tests were performed. Results: Over a median follow-up of 17.1 years, 438 HF events occurred. Individuals without T2DM, with enlarged chambers had HF incidence rates comparable to or higher than individuals with T2DM and normal chambers: LA volume 16.4 vs 8.7 (p = 0.001), LV volume 8.1 vs 8.9 (p = 0.66), and LV mass 10.1 vs 8.9 (p = 0.55) per 1000 person-years. After multivariable adjustment, compared with normal chambers, enlarged LA (HR 2.5[1.9–3.3]), LV (HR 3.5[2.3–5.4]), and LV mass (HR 3.2[2.2–4.9]) remained independently associated with HF in individuals without T2DM. Conclusion: AI-derived cardiac chamber enlargement measured in CAC scans is associated with HF incidence in individuals without T2DM, supporting its potential utility in HF risk stratification.