Heart Failure and Preserved Ejection Fraction in African-Americans: The ARIC Study

Gupta, Deepak K.; Shah, Amil M.; Castagno, Davide; Takeuchi, M.; Loehr, Laura R.; Fox, Ervin R.; Butler, Kenneth R.; Mosley, Thomas H.; Kitzman, Dalane W.; Solomon, Scott D.

doi:10.1016/j.cardfail.2012.06.330

Cited by 17 publications

(45 citation statements)

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“…8,21-27 A notable exception is African Americans with HFpEF from the Jackson, MS site of the NHLBI ARIC study, who demonstrated an even higher prevalence of LV hypertrophy than seen in this cohort. 24 In general, the pattern of ventricular remodeling noted in TOPCAT more closely approximated that from a large HFpEF registry.ww…”

Section: Discussionmentioning

confidence: 68%

Cardiac Structure and Function in Heart Failure With Preserved Ejection Fraction

Shah

Shah²,

Anand³

et al. 2014

Circ: Heart Failure

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Background Heart failure with preserved ejection fraction (HFpEF) is associated with substantial morbidity and mortality. Existing data on cardiac structure and function in HFpEF suggests significant heterogeneity in this population. Methods and Results Echocardiograms were obtained from 935 patients with HFpEF (left ventricular ejection fraction [LVEF] ≥45%) enrolled in the Treatment Of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial prior to initiation of randomized therapy. Average age was 70±10 years, 49% were female, 14% were of African descent, and co-morbidities were highly prevalent. Centralized quantitative analysis in a blinded core laboratory demonstrated a mean LVEF of 59.3±7.9%, with prevalent concentric LV remodeling (34%) and hypertrophy (43%), and left atrial (LA) enlargement (53%). Diastolic dysfunction was present in 66% of gradable participants, and was significantly associated with greater LV hypertrophy and a higher prevalence of LA enlargement. Doppler evidence of pulmonary hypertension was present in 36%. At least 1 measure of structural heart disease was present in 93% of patients. Conclusions Participants enrolled in TOPCAT demonstrated heterogeneous patterns of ventricular remodeling, with high prevalence of structural heart disease, including LV hypertrophy and LA enlargement, in addition to pulmonary hypertension, each of which has been associated with adverse outcomes in HFpEF. Diastolic function was normal in approximately one-third of gradable participants, highlighting the heterogeneity of the cardiac phenotype in this syndrome. These findings deepen our understanding of the TOPCAT trial population and expand our knowledge of the diversity of the cardiac phenotype in HFpEF. Clinical Trial Registration Clinicaltrials.gov Identifier NCT00094302

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Section: Discussionmentioning

confidence: 68%

Cardiac Structure and Function in Heart Failure With Preserved Ejection Fraction

Shah

Shah²,

Anand³

et al. 2014

Circ: Heart Failure

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296

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“…The pathogenesis of HF in women and African Americans may be less related to epicardial CAD and more attributable to endothelial and metabolic derangements leading to microvascular dysfunction and possibly heart failure with preserved ejection fraction (HFpEF) (44,46–49). Moreover, African Americans, despite a higher prevalence of atherosclerotic risk factors, may have a lower prevalence of CHD and perhaps a higher prevalence of HFpEF (50,51). …”

Section: Discussionmentioning

confidence: 99%

Heart Failure Risk Across the Spectrum of Ankle-Brachial Index

Gupta

Skali

Claggett

et al. 2014

JACC: Heart Failure

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Objectives To describe the relationship between ankle brachial index (ABI) and the risk for heart failure (HF). Background The ABI is a simple, non-invasive measure associated with atherosclerotic cardiovascular disease and death; however, the relationship between ABI and risk of HF is less well characterized. Methods Between 1987–1989 in the Atherosclerosis Risk in Communities study an oscillometric device was used to measure blood pressure in a single upper and randomly chosen lower extremity to determine the ABI. Incident HF events were defined by the first hospitalization with an ICD-9 code 428.x through 2008. The risk of HF was assessed across the ABI range using restricted cubic splines and Cox proportional hazards models. Results ABI was available in 13,150 participants free from prevalent HF. Over a mean 17.7 years of follow up, 1809 incident HF events occurred. After adjustment for traditional HF risk factors, prevalent CHD, subclinical carotid atherosclerosis, and interim MI, as compared to an ABI of 1.01–1.40, participants with an ABI ≤0.90 were at increased risk for HF (HR 1.40, 95% CI 1.12–1.74), as were participants with an ABI of 0.91–1.00 (HR 1.36, 95%CI 1.17–1.59). Conclusions In a middle aged community cohort, an ABI ≤ 1.00 was significantly associated with an increased risk of HF independent of traditional HF risk factors, prevalent CHD, carotid atherosclerosis, and interim MI. Low ABI may not only reflect overt atherosclerosis, but also pathologic processes in the development of HF beyond epicardial atherosclerotic disease and MI alone. A low ABI, as a simple non-invasive measure, may be a risk marker for HF.

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“…Perhaps the most comprehensive data to date on cardiac structure and function among African Americans with HFpEF comes from the NHLBI Atherosclerosis Risk in Communities (ARIC) Study’s Jackson, MS cohort. 52 Among 2,445 African American participants, the 85 identified with HF tended to demonstrate smaller LV chambers, higher LV mass and relative wall thickness, and higher prevalence of concentric hypertrophy compared to other – albeit larger – cohort studies.…”

Section: Racial/ethnic Variation In Cardiac Structure and Function Inmentioning

confidence: 92%

Ventricular Remodeling in Heart Failure with Preserved Ejection Fraction

Shah

2013

Curr Heart Fail Rep

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Heart failure with preserved ejection fraction (HFpEF) is common, increasing in prevalence, and causes substantial morbidity and mortality. HFpEF has commonly been viewed as an expression of advanced hypertensive heart disease, with a cardiac phenotype characterized by an increase in wall thickness-to-chamber radius ratio (concentric hypertrophy). However, marked clinical heterogeneity within this syndrome is now well appreciated, and is mirrored in the variability in left ventricular structure. A review of larger imaging studies from epidemiology and clinical trial cohorts demonstrate that while concentric LV remodeling is common, it is by no means universal and many patients demonstrate normal LV geometry or even an eccentric pattern. More detailed assessment of cardiac structure and function in broader HFpEF populations will be necessary to better define the prevalence, determinants, and prognostic relevance of these measures, which may in turn serve as a foundation to identify pathophysiologically relevant sub-phenotypes within this diverse syndrome.

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Heart Failure and Preserved Ejection Fraction in African-Americans: The ARIC Study

Cited by 17 publications

References 0 publications

Cardiac Structure and Function in Heart Failure With Preserved Ejection Fraction

Cardiac Structure and Function in Heart Failure With Preserved Ejection Fraction

Heart Failure Risk Across the Spectrum of Ankle-Brachial Index

Ventricular Remodeling in Heart Failure with Preserved Ejection Fraction

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