Imaging Protocol, Feasibility, and Reproducibility of Cardiovascular Phenotyping in a Large Tri-Ethnic Population-Based Study of Older People: The Southall and Brent Revisited (SABRE) Study.

Lamia Al Saikhan,Andrew Wright,Anish Bhuva,Arjun K Ghosh,Sophie Eastwood,Jamil Mayet,Ayodipupo Oguntade,Charlotte Manisty,Chloe Park,Therese Tillin,Nish Chaturvedi,Suzanne Williams,John Heasman,Muath Alobaida,Siana Jones,Alun D Hughes,Katherine March

doi:10.3389/fcvm.2020.591946

Abstract

Background: People of South Asian and African Caribbean ethnicities living in UK have a high risk of cardiometabolic disease. Limited data exist regarding detailed cardiometabolic phenotyping in this population. Methods enabling this are widely available, but the practical aspects of undertaking such studies in large and diverse samples are seldom reported.Methods: The Southall and Brent Revisited (SABRE) study is the UK's largest tri-ethnic longitudinal cohort. Over 1,400 surviving participants (58–85 years) attended the 2nd study visit (2008–2011); during which, comprehensive cardiovascular phenotyping, including 3D-echocardiography [3D-speckle-tracking (3D-STE)], computed tomography, coronary artery calcium scoring, pulse wave velocity, central blood pressure, carotid artery ultrasound, and retinal imaging, were performed. We describe the methods used with the aim of providing a guide to their feasibility and reproducibility in a large tri-ethnic population-based study of older people.Results: Conventional echocardiography and all vascular measurements showed high feasibility (>90% analyzable of clinic attendees), but 3D-echocardiography (3DE) and 3D-STE were less feasible (71% 3DE acquisition feasibility and 38% 3D-STE feasibility of clinic attendees). 3D-STE feasibility differed by ethnicity, being lowest in South Asian participants and highest in African Caribbean participants (p < 0.0001). Similar trends were observed in men (P < 0.0001) and women (P = 0.005); however, in South Asians, there were more women with unreadable 3D-images compared to men (67 vs. 58%). Intra- and inter-observer variabilities were excellent for most of conventional and advanced echocardiographic measures. The test-retest reproducibility was good-excellent and fair-good for conventional and advanced echocardiographic measures, respectively, but lower than when re-reading the same images. All vascular measures demonstrated excellent or fair-good reproducibility.Conclusions: We describe the feasibility and reproducibility of detailed cardiovascular phenotyping in an ethnically diverse population. The data collected will lead to a better understanding of why people of South Asian and African Caribbean ancestry are at elevated risk of cardiometabolic diseases.

Highlights

People of South Asian and African Caribbean descent are known to experience an increased burden of diabetes and cardiovascular disease (CVD) compared with people of European ancestry; why remains unclear [1]
In participants with atrial fibrillation or poor image quality, 3DE was not acquired, and there was a small subset of participants who had attended the clinic before the 3D probe became available; these were excluded from the denominator when feasibility was estimated. 3DE was acquired in 71% of all clinic attendees and, using QLAB, 924 (92%) had successful volumetric analysis and 897 (89.6%) had left ventricular (LV) mass calculated
We believe this is the first study to show that the feasibility of 3D-speckle-tracking echocardiography (3D-STE) seems to differ by ethnicity and gender, with the lowest level of feasibility being found in South Asian women and the highest in African Caribbean men

Summary

Introduction

People of South Asian and African Caribbean descent are known to experience an increased burden of diabetes and cardiovascular disease (CVD) compared with people of European ancestry; why remains unclear [1]. The Southall and Brent Revisited (SABRE) study was designed to address this question by establishing the relationships between risk factors, subclinical disease, and adverse clinical outcomes and mortality in a longitudinal cohort [2]. People of South Asian and African Caribbean ethnicities living in UK have a high risk of cardiometabolic disease. Limited data exist regarding detailed cardiometabolic phenotyping in this population. Methods enabling this are widely available, but the practical aspects of undertaking such studies in large and diverse samples are seldom reported

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Conclusion