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AIMS: Hypertensive patients of African ancestry (Afr-a) have higher incidences of heart failure and worse clinical outcomes than hypertensive patients of European ancestry (Eu-a), yet the underlying mechanisms remain misunderstood. This study investigated right (RV) and left (LV) ventricular remodelling alongside myocardial tissue derangements between Afr-a and Eu-a hypertensives. METHODS AND RESULTS: 63 Afr-a and 47 Eu-a hypertensives underwent multi-parametric cardiovascular magnetic resonance. Biventricular volumes, mass, function, mass/end-diastolic volume (M/V) ratios, T2 and pre-/post-contrast T1 relaxation times, synthetic extracellular volume, and myocardial fibrosis (MF) were measured. 3D shape modelling was implemented to delineate ventricular geometry. LV and RV mass (indexed to body-surface-area) and M/V ratio were significantly greater in Afr-a than Eu-a hypertensives (67.1 ± 21.7 vs. 58.3 ± 16.7â g/m2, 12.6 ± 3.48 vs. 10.7 ± 2.71â g/m2, 0.79 ± 0.21 vs. 0.70 ± 0.14â g/mL, and 0.16 ± 0.04 vs. 0.13 ± 0.03â g/mL, respectively; P < 0.03). Afr-a patients showed greater basal interventricular septum thickness than Eu-a patients, influencing LV hypertrophy and RV cavity changes. This biventricular remodelling was associated with prolonged T2 relaxation time (47.0 ± 2.2 vs. 45.7 ± 2.2â ms, P = 0.005) and higher prevalence (23% vs. 4%, P = 0.001) and extent of MF [2.3 (0.6-14.3) vs. 1.6 (0.9-2.5) % LV mass, P = 0.008] in Afr-a patients. Multivariable linear regression showed that modifiable cardiovascular risk factors and greater end-diastolic volume, but not ethnicity, were independently associated with greater LV mass. CONCLUSION: Afr-a hypertensives had distinctive biventricular remodelling, including increased RV mass, septal thickening and myocardial tissue abnormalities compared with Eu-a hypertensives. From this study, modifiable cardiovascular risk factors and ventricular geometry, but not ethnicity, were independently associated with greater LV myocardial mass.
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Población Negra , Hipertensión , Imagen por Resonancia Cinemagnética , Remodelación Ventricular , Población Blanca , Humanos , Masculino , Remodelación Ventricular/fisiología , Femenino , Persona de Mediana Edad , Hipertensión/etnología , Hipertensión/complicaciones , Imagen por Resonancia Cinemagnética/métodos , Población Blanca/estadística & datos numéricos , Población Negra/estadística & datos numéricos , Estudios de Cohortes , Anciano , Adulto , Medición de Riesgo , Miocardio/patología , Hipertrofia Ventricular Izquierda/diagnóstico por imagen , Hipertrofia Ventricular Izquierda/etnología , Hipertrofia Ventricular Izquierda/fisiopatologíaRESUMEN
BACKGROUND AND AIM: Left ventricular hypertrophy (LVH) has been shown to be associated with the occurrence of atrial fibrillation (AF). However, the predictive value of the LVH phenotype for incident AF remains uncertain. This study aimed to investigate the predictive value of LVH phenotype for incident AF. METHODS AND RESULTS: This study utilized the Multi-Ethnic Study of Atherosclerosis (MESA) data. LVH was defined by cardiac magnetic resonance measured LV mass index. Isolated LVH was determined as LVH without elevated cardiac biomarker and malignant LVH was determined as LVH with at least 1 elevated biomarker. Receiver-operating characteristic (ROC) analysis was performed to calculate areas under the curves (AUC) for predicting AF. A total of 4983 community-dwelling participants were included, with a mean age of 61.5 years. 279 (5.6 %) had isolated LVH, and 222 (4.5 %) had malignant LVH. During a median follow-up of 8.5 years, 272 incident AF was observed. Compared to participants without LVH and elevated cardiac biomarkers, those with isolated LVH (HR, 1.82; 95 % CI, 1.03-3.20) and malignant LVH (HR, 4.13; 95 % CI, 2.77-6.16) had a higher risk of incident AF. Malignant LVH carried a 1.5-fold increased risk of AF compared to isolated LVH (HR: 2.48, 95 % CI: 1.30-4.73). Including the LVH phenotype in the CHARGE-AF model improved model discrimination (AUC increase: 0.03, p < 0.001). CONCLUSIONS: The risks of AF incidence varied across LVH phenotypes. Malignant LVH carried the highest risk among LVH phenotypes. LVH phenotype provides incremental predictive value over the variables included in the CHARGE-AF model.
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Fibrilación Atrial , Hipertrofia Ventricular Izquierda , Fenotipo , Valor Predictivo de las Pruebas , Humanos , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/epidemiología , Fibrilación Atrial/etnología , Fibrilación Atrial/fisiopatología , Hipertrofia Ventricular Izquierda/diagnóstico por imagen , Hipertrofia Ventricular Izquierda/epidemiología , Hipertrofia Ventricular Izquierda/etnología , Hipertrofia Ventricular Izquierda/fisiopatología , Masculino , Femenino , Anciano , Persona de Mediana Edad , Incidencia , Medición de Riesgo , Factores de Riesgo , Estados Unidos/epidemiología , Anciano de 80 o más Años , Pronóstico , Factores de Tiempo , Función Ventricular Izquierda , Biomarcadores/sangre , Estudios ProspectivosRESUMEN
Importance: Idiopathic dilated cardiomyopathy (DCM) aggregates in families, and early detection in at-risk family members can provide opportunity to initiate treatment prior to late-phase disease. Most studies have included only White patients, yet Black patients with DCM have higher risk of heart failure-related hospitalization and death. Objective: To estimate the prevalence of familial DCM among DCM probands and the age-specific cumulative risk of DCM in first-degree relatives across race and ethnicity groups. Design, Setting, and Participants: A family-based, cross-sectional study conducted by a multisite consortium of 25 US heart failure programs. Participants included patients with DCM (probands), defined as left ventricular systolic dysfunction and left ventricular enlargement after excluding usual clinical causes, and their first-degree relatives. Enrollment commenced June 7, 2016; proband and family member enrollment concluded March 15, 2020, and April 1, 2021, respectively. Exposures: The presence of DCM in a proband. Main Outcomes and Measures: Familial DCM defined by DCM in at least 1 first-degree relative; expanded familial DCM defined by the presence of DCM or either left ventricular enlargement or left ventricular systolic dysfunction without known cause in at least 1 first-degree relative. Results: The study enrolled 1220 probands (median age, 52.8 years [IQR, 42.4-61.8]; 43.8% female; 43.1% Black and 8.3% Hispanic) and screened 1693 first-degree relatives for DCM. A median of 28% (IQR, 0%-60%) of living first-degree relatives were screened per family. The crude prevalence of familial DCM among probands was 11.6% overall. The model-based estimate of the prevalence of familial DCM among probands at a typical US advanced heart failure program if all living first-degree relatives were screened was 29.7% (95% CI, 23.5% to 36.0%) overall. The estimated prevalence of familial DCM was higher in Black probands than in White probands (difference, 11.3% [95% CI, 1.9% to 20.8%]) but did not differ significantly between Hispanic probands and non-Hispanic probands (difference, -1.4% [95% CI, -15.9% to 13.1%]). The estimated prevalence of expanded familial DCM was 56.9% (95% CI, 50.8% to 63.0%) overall. Based on age-specific disease status at enrollment, estimated cumulative risks in first-degree relatives at a typical US advanced heart failure program reached 19% (95% CI, 13% to 24%) by age 80 years for DCM and 33% (95% CI, 27% to 40%) for expanded DCM inclusive of partial phenotypes. The DCM hazard was higher in first-degree relatives of non-Hispanic Black probands than non-Hispanic White probands (hazard ratio, 1.89 [95% CI, 1.26 to 2.83]). Conclusions and Relevance: In a US cross-sectional study, there was substantial estimated prevalence of familial DCM among probands and modeled cumulative risk of DCM among their first-degree relatives. Trial Registration: ClinicalTrials.gov Identifier: NCT03037632.
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Cardiomiopatía Dilatada/epidemiología , Salud de la Familia/estadística & datos numéricos , Grupos Raciales/estadística & datos numéricos , Adulto , Factores de Edad , Población Negra/estadística & datos numéricos , Cardiomiopatía Dilatada/diagnóstico , Cardiomiopatía Dilatada/etnología , Intervalos de Confianza , Estudios Transversales , Diagnóstico Precoz , Salud de la Familia/etnología , Femenino , Hispánicos o Latinos/estadística & datos numéricos , Humanos , Hipertrofia Ventricular Izquierda/diagnóstico , Hipertrofia Ventricular Izquierda/epidemiología , Hipertrofia Ventricular Izquierda/etnología , Masculino , Persona de Mediana Edad , Prevalencia , Grupos Raciales/etnología , Riesgo , Estados Unidos/epidemiología , Disfunción Ventricular Izquierda/diagnóstico , Disfunción Ventricular Izquierda/epidemiología , Disfunción Ventricular Izquierda/etnología , Población Blanca/estadística & datos numéricosRESUMEN
BACKGROUND: This study aimed to assess the relationship of a new anthropometric index with left ventricular hypertrophy (LVH) in hypertensive patients among the Han Chinese. METHODS: The study is a community-based cross-sectional study that included 4639 patients with hypertension and integrated clinical and echocardiographic data. Left ventricular (LV) mass was measured by transthoracic echocardiography. LVH was diagnosed by using the criteria of left ventricular mass indexed (LVMI) over 49.2 g/m2.7 for men and 46.7 g/m2.7 for women. Quartiles of a body shape index (ABSI), body roundness index (BRI), waist circumference (WC), and body mass index (BMI) were used regarding LVH prevalence. The logistic regression model was used to determine the odds ratio (OR) and 95% confidence intervals (CI) of the new anthropometric index and LVH. Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive ability of the obesity indices for LVH risk. RESULTS: The prevalence of LVH increased across quartiles for ABSI, BRI, BMI, and WC. Comparing the lowest with the highest quartile, adjusted OR (95% CI) for LVH were significantly different for BRI 3.86 (3.12-4.77), BMI 3.54 (2.90-4.31), and WC 2.29 (1.88-2.78). No association was observed for ABSI. According to ROC analysis, the area under the curve (AUC) of BRI was (AUC: 0.653, 95% CI 0.637-0.669), BMI (AUC: 0.628, 95% CI 0.612-0.644), WC (AUC: 0.576, 95% CI 0.559-0.593), ABSI (AUC: 0.499, 95% CI 0.482-0.516). CONCLUSIONS: This study shows that LVH prevalence increased per quartile across the Han Chinese population with hypertension for ABSI, BRI, BMI, and WC. There is a significant association between BRI and LVH in hypertensive people, while ABSI was not. BRI showed potential for use as an alternative obesity measure in the assessment of LVH.
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Antropometría/métodos , Etnicidad , Hipertensión/complicaciones , Hipertrofia Ventricular Izquierda/fisiopatología , China/epidemiología , Estudios Transversales , Femenino , Humanos , Hipertensión/etnología , Hipertensión/fisiopatología , Hipertrofia Ventricular Izquierda/etnología , Hipertrofia Ventricular Izquierda/etiología , Masculino , Persona de Mediana Edad , Morbilidad/tendenciasRESUMEN
BACKGROUND: Left ventricular hypertrophy is a pathophysiological response often due to chronic uncontrolled hypertension. Our primary aim was to investigate the magnitude, correlates and outcomes of left ventricular hypertrophy as a surrogate maker for chronic uncontrolled hypertension in young adults ≤ 45 years with stroke. Our secondary aim was to determine the accuracy of electrocardiography using Sokolow-Lyon and Cornell criteria in detecting left ventricular hypertrophy compared to echocardiography. METHODS: This cohort study recruited young strokes who had undergone brain imaging, electrocardiography and transthoracic echocardiography at baseline. The modified Poisson regression model examined baseline correlates for left ventricular hypertrophy. The National Institute of Health Stroke Scale assessed stroke severity and the modified Rankin Scale assessed outcomes to 30-days. Performance of electrical voltage criterions was estimated using receiver operator characteristics. RESULTS: We enrolled 101 stroke participants. Brain imaging revealed ischemic strokes in 60 (59.4%) and those with intracerebral hemorrhage, 33 (86.8%) were localized to the basal ganglia. Left ventricular hypertrophy was present in 76 (75.3%:95%CI 65.7%-83.3%), and 30 (39.5%) and 28 (36.8%) had moderate or severe hypertrophy respectively. Young adults with premorbid or a new diagnosis of hypertension were more likely to have left ventricular hypertrophy, 47 (61.8%), and 26 (34.2%). On multivariable analysis, left ventricular hypertrophy was independently associated with not being on anti-hypertensive medications among hypertensives participants {adjusted risk ratio 1.4 (95%CI:1.04-1.94). The mean National Institute of Health Stroke score was 18 and 30-day mortality was 42 (43.3%). The sensitivity and specificity for Sokolow-Lyon in detecting left ventricular hypertrophy was 27% and 78%, and for Cornell was 32% and 52% respectively. CONCLUSIONS: We identified a high proportion of left ventricular hypertrophy in young adults with stroke associated with chronic undertreated hypertension. While the study methodology does not allow us to determine causation, this association and knowledge of pathophysiological processes supports the notion that chronic hypertension is a major risk factor for young strokes associated with high mortality. Our findings did not support the use of the electrical voltage criteria for detecting left ventricular hypertrophy. We recommend low cost interventions like blood pressure screening and treatment to reduce this burden.
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Población Negra , Hipertensión/etnología , Hipertrofia Ventricular Izquierda/etnología , Accidente Cerebrovascular/etnología , Adolescente , Adulto , Edad de Inicio , Presión Sanguínea , Ecocardiografía , Electrocardiografía , Femenino , Humanos , Hipertensión/diagnóstico , Hipertensión/mortalidad , Hipertensión/fisiopatología , Hipertrofia Ventricular Izquierda/diagnóstico por imagen , Hipertrofia Ventricular Izquierda/mortalidad , Hipertrofia Ventricular Izquierda/fisiopatología , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Medición de Riesgo , Factores de Riesgo , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/fisiopatología , Tanzanía/epidemiología , Factores de Tiempo , Función Ventricular Izquierda , Remodelación Ventricular , Adulto JovenRESUMEN
BACKGROUND: Conflicting information exists regarding the association between insulin resistance (IR) and left ventricular hypertrophy (LVH). We described the associations between obesity, fasting insulinemia, homeostasis model assessment of insulin resistance (HOMA-IR), and LVH in Black patients with essential hypertension. METHODS: A case-control study was conducted at the Centre Médical de Kinshasa (CMK), the Democratic Republic of the Congo, between January and December 2019. Cases and controls were hypertensive patients with and without LVH, respectively. The relationships between obesity indices, physical inactivity, glucose metabolism and lipid disorder parameters, and LVH were assessed using linear and logistic regression analyses in simple and univariate exploratory analyses, respectively. When differences were observed between LVH and independent variables, the effects of potential confounders were studied through the use of multiple linear regression and in conditional logistic regression in multivariate analyses. The coefficients of determination (R2), adjusted odds ratios (aORs), and their 95% confidence intervals (95% CIs) were calculated to determine associations between LVH and the independent variables. RESULTS: Eighty-eight LVH cases (52 men) were compared against 132 controls (81 men). Variation in left ventricular mass (LVM) could be predicted by the following variables: age (19%), duration of hypertension (31.3%), body mass index (BMI, 44.4%), waist circumference (WC, 42.5%), glycemia (20%), insulinemia (44.8%), and HOMA-IR (43.7%). Hypertension duration, BMI, insulinemia, and HOMA-IR explained 68.3% of LVM variability in the multiple linear regression analysis. In the logistic regression model, obesity increased the risk of LVH by threefold [aOR 2.8; 95% CI (1.06-7.4); p = 0.038], and IR increased the risk of LVH by eightfold [aOR 8.4; 95 (3.7-15.7); p < 0.001]. CONCLUSION: Obesity and IR appear to be the primary predictors of LVH in Black sub-Saharan African hypertensive patients. The comprehensive management of cardiovascular risk factors should be emphasized, with particular attention paid to obesity and IR. A prospective population-based study of Black sub-Saharan individuals that includes the use of serial imaging remains essential to better understand subclinical LV deterioration over time and to confirm the role played by IR in Black sub-Saharan individuals with hypertension.
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Población Negra , Hipertensión Esencial/etnología , Hipertrofia Ventricular Izquierda/etnología , Resistencia a la Insulina/etnología , Adulto , Biomarcadores/sangre , Glucemia/metabolismo , Presión Sanguínea , Estudios de Casos y Controles , República Democrática del Congo/etnología , Hipertensión Esencial/diagnóstico , Hipertensión Esencial/fisiopatología , Femenino , Humanos , Hipertrofia Ventricular Izquierda/diagnóstico por imagen , Hipertrofia Ventricular Izquierda/fisiopatología , Insulina/sangre , Masculino , Persona de Mediana Edad , Obesidad/etnología , Medición de Riesgo , Factores de Riesgo , Función Ventricular Izquierda , Remodelación VentricularRESUMEN
Background: Left ventricular hypertrophy (LVH) and diastolic dysfunction are correlated with obesity and hypertension in adult patients, but few studies have investigated the association between obesity itself and left ventricular function in children. The aim of this study was to evaluate the effect of obesity and LVH on left ventricular diastolic function in pediatric subjects compared with children without obesity. Methods: A number of 454 patients from an outpatient cardiology service were enrolled in a prospective study, 33 children with obesity, 20 overweight children, and 401 children without obesity. The subjects were assigned to three groups according to age and school grade. A standardized two-dimensional echocardiography analysis was performed in all children. The evaluated echocardiographic parameters included thickness of the interventricular septum (IVS), thickness of the posterior wall of the left ventricle, and left atrium size. The left ventricular diastolic function was analyzed by the classic pulsed-wave Doppler technique, tissue Doppler technique, and continuous Doppler technique. Results: The number of children with obesity was higher in the school and adolescent groups. The median age of children with obesity was 9 years. The subjects were classified according to blood pressure values in hypertensive, with high-normal blood pressure/prehypertension and with normal blood pressure values. Standard echocardiography showed that children with obesity had significantly increased thickness of the IVS and of the posterior wall compared with nonobesity subjects (P < 0.001). Left ventricular systolic function was preserved in both groups. Diastolic function was normal in the obesity group and in the non-obesity group, respectively. Conclusions: The results of this study demonstrate that childhood obesity is associated with significant changes in the myocardial structure consisting of LVH, but we did not find an early alteration in the left ventricular diastolic function of the subjects with obesity compared with patients with a normal weight.
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Diástole , Hipertrofia Ventricular Izquierda , Obesidad Infantil , Niño , Diástole/fisiología , Humanos , Hipertrofia Ventricular Izquierda/etnología , Obesidad Infantil/etnología , Obesidad Infantil/fisiopatología , Estudios Prospectivos , Población BlancaRESUMEN
BACKGROUND: Prior studies have found that sleep-disordered breathing (SDB) is common among those with left ventricular (LV) dysfunction and heart failure. Few epidemiological studies have examined this association, especially in US Hispanic/Latinos, who may be at elevated risk of SDB and heart failure. METHODS: We examined associations between SDB and LV diastolic and systolic function using data from 1506 adults aged 18 to 64 years in the Hispanic Community Health Study/Study of Latinos ECHO-SOL Ancillary Study (2011-2014). Home sleep testing was used to measure the apnea-hypopnea index, a measure of SDB severity. Echocardiography was performed a median of 2.1 years later to quantify LV diastolic function, systolic function, and structure. Multivariable linear regression was used to model the association between apnea-hypopnea index and echocardiographic measures while accounting for the complex survey design, demographics, body mass, and time between sleep and echocardiographic measurements. RESULTS: Each 10-unit increase in apnea-hypopnea index was associated with 0.2 (95% CI, 0.1-0.3) lower E', 0.3 (0.1-0.5) greater E/E' ratio, and 1.07-fold (1.03-1.11) higher prevalence of diastolic dysfunction as well as 1.3 (0.3-2.4) g/m2 greater LV mass index. These associations persisted after adjustment for hypertension and diabetes mellitus. In contrast, no association was identified between SDB severity and subclinical markers of LV systolic function. CONCLUSIONS: Greater SDB severity was associated with LV hypertrophy and subclinical markers of LV diastolic dysfunction. These findings suggest SDB in Hispanic/Latino men and women may contribute to the burden of heart failure in this population.
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Insuficiencia Cardíaca/fisiopatología , Hipertrofia Ventricular Izquierda/fisiopatología , Síndromes de la Apnea del Sueño/fisiopatología , Disfunción Ventricular Izquierda/fisiopatología , Función Ventricular Izquierda , Remodelación Ventricular , Adolescente , Adulto , Anciano , Estudios Transversales , Diástole , Ecocardiografía , Femenino , Insuficiencia Cardíaca/diagnóstico por imagen , Insuficiencia Cardíaca/etnología , Hispánicos o Latinos , Humanos , Hipertrofia Ventricular Izquierda/diagnóstico por imagen , Hipertrofia Ventricular Izquierda/etnología , Pulmón/fisiopatología , Masculino , Persona de Mediana Edad , Prevalencia , Pronóstico , Estudios Prospectivos , Factores Raciales , Respiración , Medición de Riesgo , Factores de Riesgo , Índice de Severidad de la Enfermedad , Sueño , Síndromes de la Apnea del Sueño/diagnóstico , Síndromes de la Apnea del Sueño/etnología , Estados Unidos/epidemiología , Disfunción Ventricular Izquierda/diagnóstico por imagen , Disfunción Ventricular Izquierda/etnología , Adulto JovenRESUMEN
PRKAG2 syndrome (PS) is a rare autosomal dominant syndrome that mainly presents with hypertrophic cardiomyopathy, ventricular preexcitation, and conduction abnormalities. Few reports have demonstrated the morphologic manifestation of patients with PRKAG2 gene defect. This case report demonstrates the cardiac magnetic resonance characteristics of the PS patients from a Chinese family.
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Proteínas Quinasas Activadas por AMP/genética , Hipertrofia Ventricular Izquierda/diagnóstico por imagen , Hipertrofia Ventricular Izquierda/genética , Imagen por Resonancia Cinemagnética , Mutación , Disfunción Ventricular Izquierda/diagnóstico por imagen , Disfunción Ventricular Izquierda/genética , Adolescente , Pueblo Asiatico/genética , China , Electrocardiografía , Femenino , Predisposición Genética a la Enfermedad , Humanos , Hipertrofia Ventricular Izquierda/etnología , Hipertrofia Ventricular Izquierda/fisiopatología , Masculino , Fenotipo , Valor Predictivo de las Pruebas , Síndrome , Disfunción Ventricular Izquierda/etnología , Disfunción Ventricular Izquierda/fisiopatología , Función Ventricular Izquierda , Función Ventricular Derecha , Remodelación VentricularRESUMEN
RATIONALE: Data are limited regarding the influence of life-course cumulative burden of increased body mass index (BMI) and elevated blood pressure (BP) on the progression of left ventricular (LV) geometric remodeling in midlife. OBJECTIVE: To investigate the dynamic changes in LV mass and LV geometry over 6.4 years during midlife and to examine whether the adverse progression of LV geometric remodeling is influenced by the cumulative burden of BMI and BP from childhood to adulthood. METHODS AND RESULTS: The study consisted of 877 adults (604 whites and 273 blacks; 355 males; mean age=41.4 years at follow-up) who had 5 to 15 examinations of BMI and BP from childhood and 2 examinations of LV dimensions at baseline and follow-up 6.4 years apart during adulthood. The area under the curve (AUC) was calculated as a measure of long-term burden (total AUC) and trends (incremental AUC) of BMI and systolic BP (SBP). After adjusting for age, race, sex, smoking, alcohol drinking, and baseline LV mass index, the annual increase rate of LV mass index was associated with all BMI measures (ß=0.16-0.36, P<0.05 for all), adult SBP (ß=0.07, P=0.04), and total AUC of SBP (ß=0.09, P=0.01) but not with childhood and incremental AUC values of SBP. All BMI and SBP measures (except childhood SBP) were significantly associated with increased risk of incident LV hypertrophy, with odds ratios of BMI (odds ratio=1.85-2.74, P<0.05 for all) being significantly greater than those of SBP (odds ratio=1.09-1.34, P<0.05 for all except childhood SBP). In addition, all BMI measures were significantly and positively associated with incident eccentric and concentric LV hypertrophy. CONCLUSIONS: Life-course cumulative burden of BMI and BP is associated with the development of LV hypertrophy in midlife, with BMI showing stronger associations than BP. Visual Overview: An online visual overview is available for this article.
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Presión Sanguínea , Índice de Masa Corporal , Ventrículos Cardíacos/crecimiento & desarrollo , Hipertrofia Ventricular Izquierda/epidemiología , Obesidad/epidemiología , Adulto , Población Negra/estadística & datos numéricos , Niño , Femenino , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Hipertrofia Ventricular Izquierda/etnología , Masculino , Obesidad/etnología , Población Blanca/estadística & datos numéricosRESUMEN
INTRODUCTION: Black populations may be more likely to have primary aldosteronism (PA) due to adrenal hyperplasia or other forms of adrenal hyperactivity, with suppressed renin levels and high levels of aldosterone, which may contribute to the development of hypertension. METHODS: This sub-study involved 35 black men matched for age, gender and race, and aged 20-65 years, living in the North West Province of South Africa. RAAS triple-A analysis was carried out with LC-MS/MS quantification. Blood pressure, electrocardiography and other variables were determined with known methods. RESULTS: Hypertensive subjects with higher aldosterone levels showed an increased aldosterone-angiotensin II ratio (AA2 ratio) compared to the hypertensive subjects with low aldosterone levels (10.2 vs 3.0 pmol/l; p = 0.003). The serum potassium concentration was significantly lower in the high-aldosterone group and the serum sodium-potassium ratio was significantly higher compared to the low-aldosterone group (3.9 vs 4.5, p = 0.016, 34.8 vs 31.8, p = 0.032, respectively). Furthermore, aldosterone was positively associated with both left ventricular hypertrophy (Cornell product) (Spearman R = 0.560; p = 0.037) and kidney function [albumin-to-creatinine ratio (ACR) ] (Spearman R = 0.589, p = 0.021) in the hypertensive high-serum aldosterone group. CONCLUSIONS: The AA2 ratio, a novel screening test that is currently being validated for PA case detection, was used to identify a PA-like phenotype in black men. Excess aldosterone was associated with endothelial dysfunction and left ventricular hypertrophy, independent of blood pressure.
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Aldosterona/sangre , Angiotensina II/sangre , Población Negra , Hiperaldosteronismo/etnología , Hipertensión/etnología , Hipertrofia Ventricular Izquierda/etnología , Adulto , Factores de Edad , Anciano , Biomarcadores/sangre , Presión Sanguínea , Humanos , Hiperaldosteronismo/sangre , Hiperaldosteronismo/diagnóstico , Hiperaldosteronismo/fisiopatología , Hipertensión/sangre , Hipertensión/diagnóstico , Hipertensión/fisiopatología , Hipertrofia Ventricular Izquierda/sangre , Hipertrofia Ventricular Izquierda/diagnóstico , Hipertrofia Ventricular Izquierda/fisiopatología , Masculino , Persona de Mediana Edad , Fenotipo , Factores Raciales , Medición de Riesgo , Factores de Riesgo , Factores Sexuales , Sudáfrica , Función Ventricular Izquierda , Remodelación Ventricular , Adulto JovenRESUMEN
OBJECTIVE(S): To examine racial differences in the relationship between cardiovascular (CV) risk factors measured since age 10 years and left ventricular mass index (LVMI) in adulthood in the National Heart, Lung, and Blood Institute Growth and Health Study. STUDY DESIGN: Longitudinal investigation with CV risk factors measured throughout childhood and LVMI measured in adulthood. In total, 556 black and white girls were recruited from schools in the greater Cincinnati area. Analyses examined traditional CV risk factors at baseline, follow-up, and over time (ie, area under the curve [AUC]). LVMI was collected with 2-dimensional guided echocardiographic imaging at a mean age of 25.7 ± 1.7 years. RESULTS: Black girls had higher adiposity and insulin and lower heart rate across time (all P < .05). Blacks had higher LVMI compared with whites in adulthood. Major determinants of young adult LVMI, were race, body mass index z score AUC, systolic blood pressure z score AUC, percent body fat by skin fold AUC, heart rate AUC, and an interaction between race and heart rate (model R2 = 0.40, P < .0001). CONCLUSIONS: The major determinants of LVMI in young female adults are race, adiposity, and systolic blood pressure.
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Presión Sanguínea/fisiología , Ventrículos Cardíacos/diagnóstico por imagen , Hipertrofia Ventricular Izquierda/etnología , Obesidad/complicaciones , Grupos Raciales , Medición de Riesgo/métodos , Función Ventricular Izquierda/fisiología , Adolescente , Adulto , Niño , Ecocardiografía/métodos , Femenino , Estudios de Seguimiento , Ventrículos Cardíacos/fisiopatología , Humanos , Hipertrofia Ventricular Izquierda/diagnóstico , Hipertrofia Ventricular Izquierda/etiología , Masculino , Obesidad/etnología , Factores de Riesgo , Estados Unidos/epidemiología , Adulto JovenRESUMEN
BACKGROUND: Cardiac adaptation to intense physical training is determined by many factors including age, gender, body size, load training and ethnicity. Despite the wide availability of ECG analysis, with a higher presence of abnormalities in different races, echocardiographic studies on young Afro-Caribean (AA) and Caucasian athletes (CA) are lacking in literature. We aimed to assess the effect in the secondary LV remodelling of load training in young AA players compared to matched CA players. METHOD: Seventy-seven AA and 53 CA matched soccer players (mean age 17.35 ± 0.50 and 18.25 ± 0.77 y) were enrolled. They were evaluated with echocardiography. A subgroup of 30 AA and 27 CA were followed up for a period of 4 years. The myocardial contractile function was evaluated by speckle-tracking echocardiographic global longitudinal strain (GLS). RESULTS: No significant differences were found in weight and height and in blood pressure response to maximal ergometer test in either group. In AA a higher level of LV remodelling, consisting in higher LV wall thickness, higher interventricular septum (IVS) and posterior wall (PW) thickness were found (IVS: 10.04 ± 0.14 and 9.35 ± 0.10 in AA and CA respectively, p < 0.001. PW: 9.70 ± 0.20 and 9.19 ± 0.10 mm in AA and CA respectively, p < 0.05). Strain data showed no significant differences between the two groups (22.35 ± 0.48 and 23.38 ± 0.69 in AA (n = 27) and CA (n = 25), respectively). At the beginning of the follow-up study AA showed a significantly higher left ventricular remodelling (IVS = 9.29 ± 0.3 and 8.53 ± 0.12 mm in AA and CA respectively, p < 0.002. PW = 9.01 ± 0.2 and 8.40 ± 0.20 in AA and CA respectively, p = 0.1). During the next four years of follow-up we observed a regular parallel increase in LV wall thickness and chamber diameters in both groups, proportionally to the increase in body size and LV mass. (IVS = 10.52 ± 0.17 and 9.03 ± 0.22 mm in AA and CA respectively, p < 0.001. PW: 10.06 ± 0.17 and 8.26 ± 0.19 mm in AA and CA respectively, p < 0.001). CONCLUSION: The study shows that the ventricular remodelling observed in AA appears to be a specific phenotype already present in pre-adolescence. These data also suggest that genetic/ethnic factors play a central role in left ventricular remodelling during the first years of life in elite athletes.
Asunto(s)
Atletas , Negro o Afroamericano , Ecocardiografía/métodos , Ventrículos Cardíacos/diagnóstico por imagen , Hipertrofia Ventricular Izquierda/etnología , Función Ventricular Izquierda/fisiología , Remodelación Ventricular/fisiología , Adolescente , Región del Caribe/epidemiología , Electrocardiografía , Ventrículos Cardíacos/fisiopatología , Humanos , Hipertrofia Ventricular Izquierda/diagnóstico , Hipertrofia Ventricular Izquierda/fisiopatología , Incidencia , Masculino , Contracción Miocárdica/fisiologíaRESUMEN
Black Americans suffer disproportionately from hypertension and hypertensive heart disease. Out-of-office blood pressure (BP) is more predictive for cardiovascular complications than clinic BP; however, the relative abilities of clinic and out-of-office BP to predict left ventricular hypertrophy in black and white adults have not been established. Thus, we aimed to compare associations of out-of-office and clinic BP measurement with left ventricular hypertrophy by cardiac magnetic resonance imaging among non-Hispanic black and white adults. In this cross-sectional study, 1262 black and 927 white participants of the Dallas Heart Study ages 30 to 64 years underwent assessment of standardized clinic and out-of-office (research staff-obtained) BP and left ventricular mass index. In multivariable-adjusted analyses of treated and untreated participants, out-of-office BP was a stronger determinant of left ventricular hypertrophy than clinic BP (odds ratio per 10 mm Hg, 1.48; 95% CI, 1.34-1.64 for out-of-office systolic BP and 1.15 [1.04-1.28] for clinic systolic BP; 1.71 [1.43-2.05] for out-of-office diastolic BP, and 1.03 [0.86-1.24] for clinic diastolic BP). Non-Hispanic black race/ethnicity, treatment status, and lower left ventricular ejection fraction were also independent determinants of hypertrophy. Among treated Blacks, the differential association between out-of-office and clinic BP with hypertrophy was more pronounced than in treated white or untreated participants. In conclusion, protocol-driven supervised out-of-office BP monitoring provides important information that cannot be gleaned from clinic BP assessment alone. Our results underscore the importance of hypertension management programs outside the medical office to prevent hypertensive heart disease, especially in high-risk black adults. Clinical Trial Registration- URL: https://www.clinicaltrials.gov. Unique identifier: NCT00344903.
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Negro o Afroamericano/estadística & datos numéricos , Monitoreo Ambulatorio de la Presión Arterial/métodos , Hipertensión/complicaciones , Hipertensión/diagnóstico , Hipertrofia Ventricular Izquierda/etiología , Imagen por Resonancia Cinemagnética/métodos , Adulto , Factores de Edad , Antihipertensivos/uso terapéutico , Teorema de Bayes , Determinación de la Presión Sanguínea/métodos , Estudios Transversales , Electrocardiografía/métodos , Femenino , Estudios de Seguimiento , Humanos , Hipertensión/tratamiento farmacológico , Hipertensión/etnología , Hipertrofia Ventricular Izquierda/diagnóstico por imagen , Hipertrofia Ventricular Izquierda/etnología , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Medición de Riesgo , Índice de Severidad de la Enfermedad , Factores Sexuales , Texas , Población Blanca/estadística & datos numéricosRESUMEN
BACKGROUND: Arsenic exposure has been related to numerous adverse cardiovascular outcomes. The aim of this study was to investigate the cross-sectional and prospective association between arsenic exposure with echocardiographic measures of left ventricular (LV) geometry and functioning. METHODS: A total of 1337 young adult participants free of diabetes mellitus and cardiovascular disease were recruited from the SHFS (Strong Heart Family Study). The sum of inorganic and methylated arsenic concentrations in urine (ΣAs) at baseline was used as a biomarker of arsenic exposure. LV geometry and functioning were assessed using transthoracic echocardiography at baseline and follow-up. RESULTS: Mean follow-up was 5.6 years, and median (interquartile range) of ΣAs was 4.2 (2.8-6.9) µg/g creatinine. Increased arsenic exposure was associated with prevalent LV hypertrophy, with an odds ratio (95% CI) per a 2-fold increase in ΣAs of 1.47 (1.05-2.08) in all participants and of 1.58 (1.04-2.41) among prehypertensive or hypertensive individuals. Measures of LV geometry, including LV mass index, left atrial systolic diameter, interventricular septum, and LV posterior wall thickness, were positively and significantly related to arsenic exposure. Among measures of LV functioning, stroke volume, and ejection fraction were associated with arsenic exposure. CONCLUSIONS: Arsenic exposure was related to an increase in LV wall thickness and LV hypertrophy in young American Indians with a low burden of cardiovascular risk factors. The relationship was stronger in participants with prehypertension or hypertension, suggesting that potential cardiotoxic effects of arsenic might be more pronounced in individuals already undergoing cardiovascular adaptive mechanisms following elevated systemic blood pressure.
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Intoxicación por Arsénico/etiología , Arsenicales/efectos adversos , Contaminantes Ambientales/efectos adversos , Hipertrofia Ventricular Izquierda/inducido químicamente , Disfunción Ventricular Izquierda/inducido químicamente , Función Ventricular Izquierda/efectos de los fármacos , Remodelación Ventricular/efectos de los fármacos , Factores de Edad , Anciano , Intoxicación por Arsénico/diagnóstico por imagen , Intoxicación por Arsénico/etnología , Intoxicación por Arsénico/fisiopatología , Arsenicales/orina , Presión Sanguínea , Cardiotoxicidad , Estudios Transversales , Ecocardiografía Doppler , Exposición a Riesgos Ambientales/efectos adversos , Contaminantes Ambientales/orina , Femenino , Humanos , Hipertensión/etnología , Hipertensión/fisiopatología , Hipertrofia Ventricular Izquierda/diagnóstico por imagen , Hipertrofia Ventricular Izquierda/etnología , Hipertrofia Ventricular Izquierda/fisiopatología , Indígenas Norteamericanos , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Prospectivos , Medición de Riesgo , Factores de Riesgo , Estados Unidos/epidemiología , Disfunción Ventricular Izquierda/diagnóstico por imagen , Disfunción Ventricular Izquierda/etnología , Disfunción Ventricular Izquierda/fisiopatologíaRESUMEN
BACKGROUND: Ethnicity is an important determinant of athletes' cardiovascular adaptation. Black adolescent and adult athletes exhibit a left ventricular (LV) hypertrophy with a concentric remodelling higher than their Caucasian counterparts. Scant data, however, are available on race-related differences in hemodynamic response of adolescent athletes to exercise and its relation with heart remodelling. We evaluated if race-specific, sport-related structural and electrical remodelling in adolescent athletes of Caucasian and African ethnicity exclusively depends on race itself rather than on different cardiovascular responses to physical exercise. METHODS: We examined 90 adolescent athletes, 60 Caucasian (WA) and 30 Black (BA). All participants underwent thorough clinical, echocardiographic and stress test evaluations. RESULTS: BA had greater indexed LV mass (LVM/BSA) with increased relative wall thickness (RWT) implying a concentric remodelling. BA showed higher systolic blood pressure (SBP) compared to WA during the whole exercise test. ECG data showed that BA vs WA had a significant shorter QRS duration in each step considered with a significant greater QT dispersion. BA reached a higher relative pressure peak as compared to WA. RWT was strongly influenced by ethnicity and less by SBP at peak of exercise (PE), although LVM/BSA was significantly related to SBP at PE and just marginally to age and not significantly to race. CONCLUSIONS: Black adolescent athletes showed higher SBP during all steps of exercise associated to a different trend. Ethnicity was the main determinant of RWT, suggesting that LV geometry is principally race-related rather than influenced by a different hemodynamic profile to physical activity.
Asunto(s)
Atletas , Electrocardiografía , Etnicidad , Prueba de Esfuerzo/métodos , Ejercicio Físico/fisiología , Ventrículos Cardíacos/diagnóstico por imagen , Hipertrofia Ventricular Izquierda/fisiopatología , Adolescente , Ecocardiografía , Ventrículos Cardíacos/fisiopatología , Humanos , Hipertrofia Ventricular Izquierda/diagnóstico , Hipertrofia Ventricular Izquierda/etnología , Incidencia , Italia/epidemiología , Masculino , Remodelación VentricularRESUMEN
Background We developed a new left ventricular hypertrophy ( LVH ) criterion using a machine-learning technique called Bayesian Additive Regression Trees ( BART ). Methods and Results This analysis included 4714 participants from MESA (Multi-Ethnic Study of Atherosclerosis) free of clinically apparent cardiovascular disease at enrollment. We used BART to predict LV mass from ECG and participant characteristics using cardiac magnetic resonance imaging as the standard. Participants were randomly divided into a training set (n=3774) and a validation set (n=940). We compared the diagnostic/prognostic performance of our new BART - LVH criteria with traditional ECG - LVH criteria and cardiac magnetic resonance imaging- LVH . In the validation set, BART - LVH showed the highest sensitivity (29.0%; 95% CI , 18.3%-39.7%), followed by Sokolow-Lyon- LVH (21.7%; 95% CI , 12.0%-31.5%), Peguero-Lo Presti (14.5%; 95% CI , 6.2%-22.8%), Cornell voltage product (10.1%; 95% CI , 3.0%-17.3%), and Cornell voltage (5.8%; 95% CI , 0.3%-11.3%). The specificity was >93% for all criteria. During a median follow-up of 12.3 years, 591 deaths, 492 cardiovascular disease events, and 332 coronary heart disease events were observed. In adjusted Cox models, both BART - LVH and cardiac magnetic resonance imaging- LVH were associated with mortality (hazard ratio [95% CI ], 1.88 [1.45-2.44] and 2.21 [1.74-2.81], respectively), cardiovascular disease events (hazard ratio [95% CI ], 1.46 [1.08-1.98] and 1.91 [1.46-2.51], respectively), and coronary heart disease events (hazard ratio [95% CI ], 1.72 [1.20-2.47] and 1.96 [1.41-2.73], respectively). These associations were stronger than associations observed with traditional ECG - LVH criteria. Conclusions Our new BART - LVH criteria have superior diagnostic/prognostic ability to traditional ECG - LVH criteria and similar performance to cardiac magnetic resonance imaging- LVH for predicting events.
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Diagnóstico por Computador , Electrocardiografía , Hipertrofia Ventricular Izquierda/diagnóstico , Aprendizaje Automático , Imagen por Resonancia Magnética , Función Ventricular Izquierda , Remodelación Ventricular , Anciano , Anciano de 80 o más Años , Teorema de Bayes , Árboles de Decisión , Femenino , Humanos , Hipertrofia Ventricular Izquierda/etnología , Hipertrofia Ventricular Izquierda/fisiopatología , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Reproducibilidad de los Resultados , Estados Unidos/epidemiologíaRESUMEN
Inflammation was cross-sectionally associated with subclinical wall remodeling and hypertension. Whether longitudinal changes (∆) in inflammation, myocyte injury (troponin T), and stretch (N-terminal-pro-B-type natriuretic peptide) are associated with hypertension and ECG left ventricular hypertrophy (ECG-LVH) is unclear. The first prospective analysis in Africa assessing these associations included a cohort of Black and White teachers (N = 338; aged 20-63 years). Fasting blood samples were obtained to measure tumor necrosis factor-alpha (TNF-α), cardiac troponin T (cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP). Ambulatory blood pressure, 2-lead ECG and resting 10-lead ECG values were obtained. A higher mean hypertensive status (62%) was evident in Blacks compared to Whites (44%, p < 0.001). Over 3-years, NT-proBNP increased in both ethnic groups. No associations were evident in women or in White men. In Black men, ECG-LVH at follow-up was positively associated with baseline cTnT (Adj R2 0.43; ß = 0.48; 95% CI 0.28-0.68, p < 0.001) and baseline SBP (Adj R2 0.43; ß = 0.29; 95% CI 0.09-0.49, p = 0.006). In Black men, baseline TNF-α (OR = 1.49, 95% CI 1.05-2.14, p = 0.03) and decreased ΔTNF-α (OR = 2.07, 95% CI 1.26-3.40, p = 0.004) increased the likelihood for cTnT levels ≥ 4.2 ng/L. Here, baseline NT-proBNP (OR = 1.12, 95% CI 1.01-1.23, p = 0.03) and ΔNT-proBNP progression (OR = 1.09, 95% CI 1.00-1.81, p = 0.04) increased the likelihood for 24-h hypertension. In conclusion, chronically increased levels of markers of myocyte injury accompanied by progressive myocardial stretch, reflective of cardiac metabolic overdemand, may ultimately increase hypertension and ischemic heart disease risk in a cohort of Black males.
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Hipertensión/etiología , Hipertrofia Ventricular Izquierda/etiología , Inflamación/complicaciones , Péptido Natriurético Encefálico/sangre , Fragmentos de Péptidos/sangre , Troponina T/sangre , Factor de Necrosis Tumoral alfa/sangre , Adulto , Femenino , Estudios de Seguimiento , Humanos , Hipertensión/sangre , Hipertensión/etnología , Hipertrofia Ventricular Izquierda/sangre , Hipertrofia Ventricular Izquierda/etnología , Inflamación/sangre , Inflamación/etnología , Masculino , Persona de Mediana Edad , Células Musculares , Sudáfrica , Adulto JovenRESUMEN
AIMS: There is a paucity of data regarding the changes of cardiac geometry in highly trained international and multiracial university athletes. We aimed to investigate the incidence of structural cardiac abnormalities and changes of cardiac geometry in highly trained university athletes. METHODS AND RESULTS: Comprehensive echocardiographic studies were performed in 1185 university athletes through the Check-up Your Heart Program during the 2015 Gwangju Summer Universiade. Participants were divided into two groups: normal vs. abnormal left ventricular (LV) geometry (concentric remodelling, concentric hypertrophy, or eccentric hypertrophy). Structural heart diseases associated with sudden cardiac death were not identified, but minor structural cardiac abnormalities were common in university athletes. One hundred and fifty-six athletes (13.2%) had abnormal LV geometry; concentric remodelling (n = 73, 6.2%), concentric hypertrophy (n = 25, 2.1%), and eccentric hypertrophy (n = 58, 4.9%). Abnormal LV geometry was significantly more common in athletes of African descent and in endurance, mixed, or power disciplines. In multivariate logistic regression analysis, athletes of African descent [odds ratio (OR) 2.16, 95% confidence interval (CI) 1.34-3.46; P = 0.001], endurance disciplines (OR 1.79, 95% CI 1.26-2.54; P = 0.001), and training time (OR 1.01, 95% CI 1.00-1.02; P = 0.045) were independent predictors of abnormal LV geometry. CONCLUSION: A large scale cardiovascular screening programme of the 2015 Summer Universiade demonstrated that abnormal LV geometry is not uncommon (13.2%) and concentric remodelling is the most common pattern of LV geometric change in young trained university athletes. Race, type of sport, and training time are significant predictors of abnormal LV geometry. Structural cardiac abnormalities are common in university athletes even though they are minor abnormalities.
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Atletas/estadística & datos numéricos , Ecocardiografía/estadística & datos numéricos , Ventrículos Cardíacos/diagnóstico por imagen , Hipertrofia Ventricular Izquierda/diagnóstico por imagen , Hipertrofia Ventricular Izquierda/epidemiología , Remodelación Ventricular/fisiología , Adolescente , Adulto , Ecocardiografía/métodos , Femenino , Ventrículos Cardíacos/patología , Humanos , Hipertrofia Ventricular Izquierda/etnología , Internacionalidad , Masculino , Tamizaje Masivo , Factores de Riesgo , Deportes/estadística & datos numéricos , Universidades , Adulto JovenRESUMEN
Selection due to survival or attrition might bias estimates of racial disparities in health, but few studies quantify the likely magnitude of such bias. In a large national cohort with moderate loss to follow-up, we contrasted racial differences in 2 stroke risk factors, incident hypertension and incident left ventricular hypertrophy, estimated by complete-case analyses, inverse probability of attrition weighting, and the survivor average causal effect. We used data on 12,497 black and 17,660 white participants enrolled in the United States (2003-2007) and collected incident risk factor data approximately 10 years after baseline. At follow-up, 21.0% of white participants and 23.0% of black participants had died; additionally 22.0% of white participants and 28.4% of black participants had withdrawn. Individual probabilities of completing the follow-up visit were estimated using baseline demographic and health characteristics. Adjusted risk ratio estimates of racial disparities from complete-case analyses in both incident hypertension (1.11, 95% confidence interval: 1.02, 1.21) and incident left ventricular hypertrophy (1.02, 95% confidence interval: 0.84, 1.24) were virtually identical to estimates from inverse probability of attrition weighting and survivor average causal effect. Despite racial differences in mortality and attrition, we found little evidence of selection bias in the estimation of racial differences for these incident risk factors.