Race-Related Differences in Left Ventricular Structural and Functional Remodeling in Response to Increased Afterload

Abstract

Background Chronic increasing in arterial afterload may be an important trigger for left ventricular (LV) remodeling and dysfunction that lead to heart failure (HF). Racial differences in the predisposition to HF are well described, but the underlying mechanisms remain unclear. Objective We evaluated the racial differences in arterial elastance (Ea), which reflects the arterial afterload faced by the LV, and its associations with cardiac structure and function. We hypothesize that the LV in blacks displays heightened afterload sensitivity as compared to whites. Methods We studied 5727 community-based, elderly Atherosclerosis Risk in Community (ARIC) Study participants (22% black), who underwent echocardiography between 2011 and 2013. Results Blacks were younger (75 ± 5 vs 76 ± 5 years old), more frequently women (66 vs 57%), and had higher prevalence of obesity (46 vs 31%), hypertension (94 vs 80%), and diabetes mellitus (47 vs 34%) than whites. Adjusting for these baseline differences, Ea was higher among blacks (1.96 ± 0.01 vs 1.80 ± 0.01 mmHg/mL). In blacks, Ea was associated with greater LV remodeling (LV mass index, β = 3.21 ± 0.55 g/m2, p<0.001) and higher LV filling pressures (E/e′ ratio, β = 0.42 ± 0.11, p<0.001). These relationships were not observed in whites (LV mass, β = 0.16 ± 0.32 g/m2, p=0.61, p for interaction <0.001; E/e′ratio, β = −0.32 ± 0.06, p<0.001, p for interaction <0.001).. Conclusion These community-based data suggest that black Americans display heightened afterload sensitivity as a stimulus for LV structural and functional remodeling, which may contribute to their greater risk of HF, as compared to white Americans.

Outcome in German and South African peripartum cardiomyopathy cohorts associates with medical therapy and fibrosis markers

“…However, the role of ethnicity in the pathogenesis of PPCM has never been studied. In the ARIC study, the authors showed that Black patients will preferentially develop eccentric hypertrophy rather than concentric hypertrophy, which is mainly presented by White patients . It has been suggested that eccentric remodelling in Black patients involves cardiomyocyte death and replacement fibrosis, which is characterized by an increase of collagen III .…”

Cumulative blood pressure from early adulthood to middle age is associated with left atrial remodelling and subclinical dysfunction assessed by three-dimensional echocardiography: a prospective post hoc analysis from the coronary artery risk development in young adults study

“…Higher arterial afterload combine with genetically determined myocardial hypersensibility among blacks may partly explain those racial divergences. 20 , 21 …”

Increased Afterload Augments Sunitinib-Induced Cardiotoxicity in an Engineered Cardiac Microtissue Model

“…However, the relative contribution of each of these factors remains poorly understood. Another contributing factor that may be critical in the development of LV dysfunction during sunitinib treatment is hypertension 20 , 21 , 22 . More specifically, it is not clear whether hypertension unmasks LV dysfunction or actually lowers the threshold for sunitinib cardiotoxicity.…”