Burden of Systolic and Diastolic Left Ventricular Dysfunction Among Hispanics in the United States

Abstract

Background Population-based estimates of cardiac dysfunction and clinical heart failure (HF) remain undefined among Hispanics/Latino adults. Methods and Results Participants of Hispanic/Latino origin across the US, aged 45–74 years were enrolled into the Echocardiographic Study of Latinos (ECHO-SOL) and underwent a comprehensive echocardiography exam to define left ventricular systolic dysfunction (LVSD) and left ventricular diastolic dysfunction (LVDD). Clinical HF was defined according to self-report; and those with cardiac dysfunction but without clinical HF were characterized as having subclinical or unrecognized cardiac dysfunction. Of 1,818 ECHO-SOL participants (mean age 56.4 years; 42.6% male) , 49.7% had LVSD and/or LVDD. LVSD prevalence was 3.6%, while LVDD was detected in 50.3%. Participants with LVSD were more likely to be males and current smokers (all p<0.05). Female sex, hypertension, diabetes, higher body-mass index and renal dysfunction were more common among those with LVDD (all p<0.05). In age-sex adjusted models, individuals of Central American and Cuban backgrounds were almost two-fold more likely to have LVDD compared to those of Mexican backgrounds. Prevalence of clinical HF with LVSD (HF with reduced EF) was 7.3%; prevalence of clinical HF with LVDD (HF with preserved EF) was 3.6%. 96.1% of the cardiac dysfunction seen was subclinical or unrecognized. Compared to those with clinical cardiac dysfunction, prevalent coronary heart disease was the only factor independently associated with subclinical or unrecognized cardiac dysfunction (odds ratio: 0.1; 95% confidence interval: 0.1–0.4). Conclusions Among Hispanics/Latinos, most cardiac dysfunction is subclinical or unrecognized, with a high prevalence of diastolic dysfunction. This identifies a high-risk population for the development of clinical HF.

Association of Impaired Glucose Regulation and Insulin Resistance With Cardiac Structure and Function

“…All ECHO- SOL echocardiograms were read by a certified technical reader and over-read by a board-certified cardiologist with expertise in echocardiography (Dr. Rodriguez) with COCATS level 3 advanced training in Echocardiography and ASE Board Certification in Comprehensive Adult Echocardiography. Inter-reader reliability studies have been performed and intraclass correlations were >0.80 for all measures 9, 14 indicating strong agreement.…”

“…LV geometry was defined as normal (normal LVM, normal RWT) or abnormal with abnormal LV geometry categorized as: concentric remodeling (normal LVM, increased RWT), eccentric hypertrophy (increased LVM, normal RWT), and concentric hypertrophy (increased LVM, increased RWT) 13 . Our assessment of left ventricular diastolic function (LVDD) has been previously published 14 and focused on 1) pulse-wave Doppler performed in the apical four chamber view with the sample volume placed in the mitral valve orifice at the level of the leaflet tips to obtain peak early (E) and late (A) diastolic transmitral inflow velocities; 2) tissue Doppler imaging to acquire mitral early diastolic (e’) annular velocities from the apical 4-chamber view (the average of septal and lateral annular velocities were used); 3) left atrial volume measured in biplane views indexed (LAVI) to BSA; and 4) pulsed-wave Doppler used for interrogation of pulmonary venous flow systolic (S) and diastolic (D) inflow velocities. The grading scheme for Diastolic Dysfunction (DD) was grade I (mild), grade II (moderate) or grade III (severe) incorporating previously published definitions using a combination of published ASE and Redfield definitions 12, 15 .…”

Smoking intensity and duration is associated with cardiac structure and function: the ECHOcardiographic Study of Hispanics/Latinos

“…3 Whereas the decreasing rates are encouraging, there are approximately 40 million adults still smoking cigarettes. In 2014, 10.7% of Hispanics/Latinos were current smokers and an additional 16.5% were former smokers. 4 The relationship between cardiovascular disease and tobacco use is complicated by the multiplicity of the cardiovascular effects that are a result of smoking.…”

Association of Cardiac Structure and Function With Neurocognition in Hispanics/Latinos: The Echocardiographic Study of Latinos

“…All ECHO-SOL participants gave informed consent. Further details regarding the design of the ECHO-SOL have been published 19, 20…”

“…Echocardiographic measures were classified into 4 categories as previously described19, 20: Variables of LV structure: LV end-systolic volume (LVESV) (mL), LV end-diastolic volume (mL), relative wall thickness (RWT) (mm), LV geometry (normal vs abnormal), LV mass (g), and LV mass index (LVMI) (g/m 2 ).LV geometry was classified as normal or abnormal (consisting of patterns of eccentric hypertrophy, concentric hypertrophy, or concentric remodeling) 19

Variables of LV systolic function: LV ejection fraction (EF) (%), LV stroke volume (mL), cardiac output (L/min), and peak systolic annular velocity (S′) (cm/s).

Variables of LV diastolic function: LA volumes indexed to body surface area (mL/m 2 ), mitral annular velocities (cm/s), E/e′ ratio (defined as the ratio of the early mitral inflow velocity [cm/s] to the mitral annular early diastolic velocity [cm/s]), and e′ (defined as the mitral annular early diastolic velocity [cm/s]).

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