Structural cardiac changes identified on echocardiography have been linked to short-term cardiovascular risk, but their long-term clinical significance remains uncertain. A community-based longitudinal analysis of Framingham participants published in JACC Advances evaluated whether left atrial end-systolic dimension (LASD) and left ventricular mass (LVM) were associated with long-term risk of mortality and several cardiometabolic outcomes.

Clinical covariates and up to three serial echocardiographic measurements were obtained between 1991 and 2008. Participants were followed for a median of 17 years, with observation extending up to 29 years. Analyses of incident outcomes excluded individuals with prevalent disease or missing outcome data.

Among 8,192 participants (mean age 48 ± 13 years; 54.3% women), follow-up recorded 1,245 deaths and 946 cardiovascular disease (CVD) events, along with 290 dementia events, 1,565 hypertension events, 463 diabetes events, and 583 chronic kidney disease events. Higher LASD and LVM were associated with increased risk of all outcomes except coronary heart disease (all P < 0.05). When modeled jointly, higher values were associated with greater mortality and CVD risk, including hard and atherosclerotic CVD (hazard ratio per standard deviation increased 1.18-1.28; all P < 0.001).

Higher LASD (HR 1.39; 95% CI 1.06-1.84) and LVM (HR 1.37; 95% CI 1.08-1.74) were associated with higher risk of heart failure with preserved ejection fraction, while higher LVM was associated with heart failure with reduced ejection fraction (HR 2.13; 95% CI 1.63-2.78). These findings indicate that echocardiographic structural markers may be associated with long-term risk of multiple adverse health outcomes in community populations.