Adjustment For Left Ventricular Mass Research Articles

Differences in Plaque Characteristics and Myocardial Mass: Implications for Physiological Significance.

The mechanism of the fractional flow reserve (FFR) difference according to sex has not been clearly understood. This study sought to evaluate sex differences in coronary stenosis, plaque characteristics, and left ventricular (LV) mass and their implications for physiological significance. This was a post hoc analysis of a pooled population of multicenter, international prospective cohorts. Patients (166 women and 489 men) underwent coronary computed tomography angiography (CCTA) within 90days before invasive FFR measurements were included. The minimal lumen area, percent of plaque burden, whole vessel plaque volume by composition, high-risk plaque characteristics, and LV mass were analyzed from CCTA images. Among 1,188 vessels analyzed, the FFR value was higher in women than that in men (0.85 ± 0.13 vs 0.82 ± 0.14; P = 0.001) despite a similar percentage of diameter stenosis between the sexes (45.9% ± 18.9% vs 46.1% ± 17.7%; P = 0.920). The composition of fibrofatty plaque+ necrotic core (13.1% ± 16.9% vs 21.2% ± 19.9%; P< 0.001) and frequencies of low attenuation plaque (12.7% vs 24.5%; P< 0.001) and positive remodeling (33.8% vs 45.5%; P=0.001) were lower in women than in men. Vessel, plaque, and lumen volumes were significantly smaller in women than that in men (all P< 0.001); however, no sex difference was observed in any of these parameters after adjustment for LV mass (all P > 0.10). Sex was not an independent predictor of the FFR value after adjustment for stenosis severity, plaque characteristics, and LV mass. Higher FFR values for the same stenosis severity in women can be explained by fewer high-risk plaque characteristics and smaller myocardial mass in women than that in men. (CCTA-FFR Registry for RiskPrediction;NCT04037163).

Left ventricular myocardial dysfunction in young and middle-aged ischemic stroke patients: the Norwegian stroke in the young study.

Hypertension is highly prevalent in ischemic stroke patients, but less is known about its impact on subclinical left ventricular (LV) dysfunction in such patients. Conventional and speckle tracking echocardiography was performed in 276 young (15-44 years) and middle-aged (45-60 years) ischemic stroke patients (mean age 50 ± 9 years, 66% men). Hypertension was defined as a history of hypertension, use of antihypertensive medications, persistently elevated blood pressure (BP) during hospitalization or elevated clinic BP (≥140/90 mmHg) and ambulatory BP (≥130/80 mmHg) at follow-up visits. LV myocardial dysfunction was assessed by peak systolic global longitudinal (GLS) and circumferential strain (GCS). Hypertension was present in 68% of patients and associated with higher age, BMI and LV mass, male sex and the presence of diabetes (all P < 0.01). Compared with normotensive patients, hypertensive patients had significantly lower peak systolic GLS (-16 ± 3 vs. -19 ± 2%, P < 0.001) and GCS (-16 ± 3 vs. -18 ± 4%, P < 0.001) while ejection fraction did not differ between groups (P = 0.134). In univariable regression analyses, reduced peak systolic GLS and GCS were both associated with hypertension (β = 0.43 and 0.29, respectively, both P < 0.001). The association with hypertension remained significant for GLS (β = 0.25) after adjustment for LV mass, ejection fraction, male sex, obesity and diabetes (multiple R = 0.35, P < 0.001), whereas the association of hypertension with reduced peak systolic GCS was attenuated. In ischemic stroke survivors, hypertension was associated with reduced peak systolic GLS but not GCS independent of confounders.

Markers of kidney disease and risk of subclinical and clinical heart failure in African Americans: the Jackson Heart Study.

African Americans and patients with chronic kidney disease (CKD) are at high risk for clinical heart failure (HF). In this study, we aimed to determine the association of markers of kidney disease with subclinical HF (by echocardiogram) and risk of clinical HF among a large, well-characterized community-based cohort of African American patients. We also examined whether the association of markers of kidney disease with HF was attenuated with adjustment for echocardiographic measures. We studied participants in the Jackson Heart Study, a large community-based cohort of African Americans. Estimated glomerular filtration rate (eGFR) and urine albumin:creatinine ratio (ACR) were measured at baseline. We tested the association of eGFR and urine ACR with left ventricular mass (LVM), left ventricular ejection fraction (LVEF) and physician-adjudicated incident HF. Among the 3332 participants in the study, 166 (5%) had eGFR <60 mL/min/1.73 m2 and 405 (12%) had urine ACR ≥30 mg/g. In models adjusted for demographics, comorbidity and the alternative measure of kidney disease, lower eGFR and higher urine ACR were associated with higher LVM {β-coefficient 1.54 [95% confidence interval (CI) 0.78-2.31] per 10 mL/min/1.73 m2 decrease in eGFR and 2.87 (95% CI 1.85-3.88) per doubling of urine ACR}. There was no association of eGFR and urine ACR with LVEF [β-coefficient -0.12 (95% CI -0.28-0.04) and -0.11 (95% CI -0.35-0.12), respectively]. There was no association of eGFR with the risk of incident HF [HR 1.02 (95% CI 0.91-1.14) per 10 mL/min/1.73 m2 decrease], while there was a significant association of urine ACR [HR 2.22 (95% CI 1.29-3.84) per doubling of urine ACR]. This association was only modestly attenuated with adjustment for LVM [HR 1.95 (95% CI 1.09-3.49)]. Among a community-based cohort of African Americans, lower eGFR and higher ACR were associated with higher LVM. Furthermore, higher urine ACR was associated with incident HF, which was not entirely explained by the presence of left ventricular disease.

Abstract 12894: The Relations of Central Hemodynamics and Aortic Stiffness With Cardiac Structure and Function: The Framingham Heart Study

Introduction: Relations of steady and pulsatile components of central hemodynamics and aortic stiffness with cardiac dimensions and function have not been fully elucidated. Methods: We measured mean arterial pressure (MAP, steady component of blood pressure), central pulse pressure (CPP, pulsatile component of central blood pressure), and carotid-femoral pulse wave velocity (CFPWV, a measure of aortic stiffness) by arterial tonometry in 5799 Framingham Heart Study participants (mean age 51 years, 54% women). We related these to echocardiographic left ventricular (LV) dimensions and systolic and diastolic function using multivariable-adjusted partial Pearson correlations. Results: MAP was associated positively with LV wall thickness (r=0.168; p&lt;0.0001) and LV diastolic dimension (r=0.035, p=0.006). Adjusting for MAP, CPP was positively associated with LV wall thickness and LV diastolic dimension (r=0.044 and r=0.080, both p&lt;0.0001). CFPWV was not associated significantly with LV structure (all p≥0.27) in MAP-adjusted models. MAP and CFPWV were associated negatively with LV diastolic function (E’; r=-0.140 and r=-0.153, respectively; both p&lt;0.0001). The MAP relation persisted after adjustment for LV mass and CPP (r=-0.142) and the CFPWV relation persisted after adjustment for LV mass and MAP (r=-0.108, both p&lt;0.0001). MAP and CFPWV were not associated significantly with LV fractional shortening (p≥0.10), whereas CPP was positively related (r=0.064, p&lt;0.0001). The figure shows adjusted LV diastolic dimension (Panel A) and LV wall thickness (Panel B) partioned by tertiles of MAP and CPP, and E’ partitioned by CFPWV tertiles (Panel C). Conclusions: Steady and pulsatile components of central pressure are jointly yet differentially related to LV structure and function. Higher CFPWV is related to reduced LV diastolic function, but not systolic function.

Relationship of Left Ventricular Hypertrophy and Diastolic Function With Cardiovascular and Renal Outcomes in African Americans With Hypertensive Chronic Kidney Disease

African Americans with hypertension are at high risk for adverse outcomes from cardiovascular and renal disease. Patients with stage 3 or greater chronic kidney disease have a high prevalence of left ventricular (LV) hypertrophy and diastolic dysfunction. Our goal was to study prospectively the relationships of LV mass and diastolic function with subsequent cardiovascular and renal outcomes in the African American Study of Kidney Disease and Hypertension cohort study. Of 691 patients enrolled in the cohort, 578 had interpretable echocardiograms and complete relevant clinical data. Exposures were LV hypertrophy and diastolic parameters. Outcomes were cardiovascular events requiring hospitalization or causing death; a renal composite outcome of doubling of serum creatinine or end-stage renal disease (censoring death); and heart failure. We found strong independent relationships between LV hypertrophy and subsequent cardiovascular (hazard ratio, 1.16; 95% confidence interval, 1.05-1.27) events, but not renal outcomes. After adjustment for LV mass and clinical variables, lower systolic tissue Doppler velocities and diastolic parameters reflecting a less compliant LV (shorter deceleration time and abnormal E/A ratio) were significantly (P<0.05) associated with future heart failure events. This is the first study to show a strong relationship among LV hypertrophy, diastolic parameters, and adverse cardiac outcomes in African Americans with hypertension and chronic kidney disease. These echocardiographic risk factors may help identify high-risk patients with chronic kidney disease for aggressive therapeutic intervention.

Association of blood pressure and aortic distensibility with P wave indices and PR interval: The Multi-Ethnic Study of Atherosclerosis (MESA)

IntroductionHypertension is an established risk factor for atrial fibrillation. Understanding the association of blood pressure (BP) levels and aortic distensibility with P wave indices (PWIs) and PR interval, intermediate phenotypes of atrial fibrillation, could provide insights into underlying mechanisms. MethodsThis analysis included 3180 men and women aged 45–84years participating in the Multi-Ethnic Study of Atherosclerosis, a community-based cohort in the United States. Aortic distensibility was evaluated in 2243 of these individuals using cardiac magnetic resonance imaging. PWIs and PR interval were automatically measured in standard 12-lead ECGs. Sitting BP and other cardiovascular risk factors were assessed using standardized protocols. Left ventricular mass was measured by magnetic resonance imaging. ResultsHigher systolic BP, and diastolic BPs and greater pulse pressure were associated with a significantly greater P wave terminal force. These associations, however, were markedly attenuated or disappeared after adjustment for left ventricular mass. Systolic BP, diastolic BP, and pulse pressure were not strongly associated with PR interval or maximum P wave duration. Reduced aortic distensibility was associated with a longer PR interval but not with PWIs: compared with individuals in the top quartile of aortic distensibility, participants in the lowest quartile had on average a 3.7-ms longer PR interval (95% CI: 0.7, 6.7, p=0.02), after multivariable adjustment. ConclusionIn this large community-based sample, associations of BP and aortic distensibility with PWIs and PR interval differed. These results suggest that processes linking hypertension with the electrical substrate of atrial fibrillation, as characterized by these intermediate phenotypes, are diverse.

Aortic Root Remodeling and Risk of Heart Failure in the Framingham Heart Study

The aim of this study was to investigate the association between aortic root remodeling and incident heart failure (HF). Age-associated increases in aortic root diameter (AoD) might be associated with arterial stiffening, afterload changes, cardiac remodeling, and the development of HF. The study sample consisted of participants of the Framingham Heart Study Original and Offspring cohorts who underwent serial echocardiographic measurements of AoD and continuous surveillance for new-onset HF. The AoD was measured at baseline, and the change in AoD between 8-year examination cycles was calculated. Pooled repeated observations (total 13,605 person-observations) in multivariable Cox regression analyses were used to relate baseline AoD and change in AoD to the incidence of HF on follow-up. Models were adjusted for known HF risk factors (age, sex, body mass index, blood pressure, hypertension treatment, diabetes, smoking, prior myocardial infarction, and valve disease). With adjustment for clinical risk factors, the risk of incident HF increased with greater AoD at baseline (hazard ratio: 1.19/1 SD; 95% confidence interval: 1.07 to 1.33) as well as increases in AoD over 8 years (hazard ratio: 1.20/1 SD; 95% confidence interval: 1.04 to 1.38). The AoD correlated with left ventricular mass (r = 0.50; p < 0.001). After adjustment for left ventricular mass in addition to clinical risk factors, the association of AoD with incident HF was rendered nonsignificant. Aortic root remodeling is associated with future risk of HF among middle-aged and older adults in the community, potentially because it reflects parallel ventricular-vascular remodeling in those with an enlarged aortic root. Additional studies are warranted to confirm our findings.

High-sensitivity C-reactive protein as an independent predictor of progressive myocardial functional deterioration: The multiethnic study of atherosclerosis

Systemic inflammation has been linked to the development of heart failure in population studies including Multi-Ethnic Study of Atherosclerosis (MESA), but little evidence exists regarding potential mechanism of this relationship. In this study, we used longitudinal magnetic resonance imaging follow-up analysis to examine whether C-reactive protein (CRP) levels relate to progressive myocardial functional deterioration as a potential mechanism of incident heart failure. Regional myocardial functional data from MESA participants who had baseline CRP measurement and also underwent tagged cardiac magnetic resonance imaging both at baseline and at 5-year follow-up were analyzed. Left ventricular midwall and midslice peak circumferential strain (Ecc), of which a more negative value denotes stronger regional myocardial function, was measured. Circumferential strain change was calculated as the difference between baseline and follow-up Ecc. During the follow-up period, participants (n = 785) with elevated CRP experienced a decrease in strain, independent of age, gender, and ethnicity (B = 0.081, ∆Ecc change per 1 mg/L CRP change, 95% CI 0.036-0.126, P < .001, model 1) and, additionally, beyond systolic blood pressure, heart rate, diabetes, smoking status, body mass index, current medication, and glomerular filtration rate (B = 0.099, 0.052-0.145, P < .001, model 2). The relationship remained statistically significant after further adjustment for left ventricular mass, coronary calcium score, and interim clinical coronary events (B = 0.098, 0.049-0.147, P < .001, model 3). Higher CRP levels are related to progressive myocardial functional deterioration independent of subclinical atherosclerosis and clinical coronary events in asymptomatic individuals without previous history of heart disease.

Heritability of left atrial size in the Tecumseh population.

Little is known about the determinants of atrial size, and no study has analyzed whether genetic factors are involved in the pathogenesis of LA enlargement. We studied the heritability of echocardiographic left atrial size in 290 parents from the Tecumseh Blood Pressure Study and 251 children from the Tecumseh Offspring Study. All data from the parents and children were obtained at the same field office in Tecumseh, USA. Left atrial dimension was determined echocardiographically in accordance with American Society of Echocardiography guidelines with the use of leading-edge-to-leading-edge measurements of the maximal distance between the posterior aortic root wall and the posterior left atrial wall at end systole. For correlation between the left atrial dimensions of the parents and their offspring, several models were generated to adjust the atrial dimensions in both groups for an increasing number of clinical variables. After removing the effect of age, gender, height, weight, skinfold thickness, and systolic blood pressure, parent-child correlation for left atrial size was 0.19 (P = 0.007). Further adjustment for left ventricular mass and for measuring left ventricular diastolic function increased the correlation to 0.25 (P = 0.001). The present data indicate that heredity can explain a small but definite proportion of the variance in left atrial dimension.