Rationale and Design of a Multicenter Echocardiographic Study to Assess the Relationship Between Cardiac Structure and Function and Heart Failure Risk in a Biracial Cohort of Community-Dwelling Elderly Persons

Abstract

Background Heart failure (HF) is an important public health concern particularly among persons over 65 years of age. Women and African Americans are critically understudied populations that carry a sizeable portion of the HF burden. Limited normative and prognostic data exist regarding measures of cardiac structure, diastolic function, and novel measures of systolic deformation in older adults living in the community. Methods and Results The Atherosclerosis Risk in Communities (ARIC) study is a large, predominantly biracial NHLBI-sponsored epidemiologic cohort study. Between 2011 and 2013, approximately 6,000 surviving participants, now in their seventh to ninth decade of life, are expected to return for a 5th study visit during which comprehensive 2D, Doppler, tissue Doppler, and speckle-tracking echocardiography will be performed uniformly in all cohort clinic visit participants. The following objectives will be addressed: (1) to characterize cardiac structural and functional abnormalities among the elderly and determine how these differ by gender and race/ethnicity, (2) determine the relationship between ventricular and vascular abnormalities, and (3) prospectively examine the extent to which these non-invasive measures associate with incident HF. Conclusions We describe the design, imaging acquisition and analysis methods, and quality assurance metrics for echocardiography in Visit 5 of the ARIC cohort. A better understanding of the differences in cardiac structure and function through the spectrum of HF stages in the elderly generally, and between genders and racial/ethnic groups specifically, will deepen our understanding of the pathophysiology driving HF progression in these at-risk populations and may inform novel prevention or therapeutic strategies.

Ideal Cardiovascular Health and the Prevalence and Severity of Aortic Stenosis in Elderly Patients

“…Detailed methods for echocardiography at visit 5 of the ARIC Study have been previously published 20. All the examinations were performed by certified sonographers at the 4 field centers, using the uniform equipment (Philips iE33 Ultrasound systems) and in accordance with a standardized image acquisition protocol.…”

“…Any given measure was performed by the same analyst for all echocardiographic studies. Reproducibility metrics for key measures of cardiac structure and function have been previously published 20. Intrareader reproducibility of key AV measures was performed in 20 studies with the following results: AV peak velocity: coefficient of variation, 3%; correlation coefficient, 0.98; AV mean gradient: coefficient of variation, 7%; correlation coefficient, 0.97; LVOT diameter: coefficient of variation, 4%; correlation coefficient, 0.82; AV area (AVA): coefficient of variation, 9%; correlation coefficient, 0.82.…”

Cardiovascular phenotype and prognosis of patients with heart failure induced by cancer therapy

“…Quantitative analysis on digitally acquired echocardiographic studies was performed by a single expert technician who was blinded to clinical characteristics or HF aetiology. Assessment of LV and right ventricular structure and function, and left atrial structure were performed as previously described 14. LV volumes were estimated by the Simpson method using apical two-chamber and four-chamber views, and LVEF was derived from these volumes in the standard manner.…”

Relationship Between Alcohol Consumption and Cardiac Structure and Function in the Elderly

“…10 All echocardiograms were performed using dedicated Philips iE33 Ultrasound systems with Vision 2011, using a preprogrammed acquisition protocol. All studies were acquired and stored digitally and transferred from field centers to a secure server at the Corelab, the Echocardiography Reading Center (ERC; Brigham and Women’s Hospital, Boston, MA), where echocardiographic measures were performed and over read, using proprietary validated echocardiographic analysis software.…”