Abstract 023: Left Ventricular Hypertrophy and Elevated Biomarkers of Chronic Myocardial Injury May Identify African Americans With a Very High Risk for Heart Failure Development: Findings From The Jackson Heart Study

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Ambarish PANDEY ◽  
Neil Keshvani ◽  
Colby Ayers ◽  
Adolfo Correa ◽  
Mark Drazner ◽  
...  
Keyword(s):  
High Risk ◽  
African Americans ◽  
Left Ventricular Hypertrophy ◽  
Ventricular Hypertrophy ◽  
Myocardial Injury ◽  
Significant Risk ◽  
Left Ventricular ◽  
Jackson Heart Study ◽  
Heart Study

Introduction: African Americans (AA) have a disproportionate greater burden of risk factors and higher risk of HF than Whites. However, the factors underlying the transition from at-risk to clinical HF in AA is not well understood. We aimed to examine the independent and joint effects of subclinical myocardial injury, as measured by highly sensitive assays for cardiac troponin (hs-TnI) and left ventricular hypertrophy (LVH), on risk of HF in AA. Methods: Participants from the Jackson Heart Study, a prospective study of AA adults, without prevalent HF at baseline (2000-2004) were stratified into categories based on elevation in hs-cTnI (>6 ng/L) and presence of LVH (LV mass > 96 g/m 2 in women and > 116 g/m 2 in men). The risk of incident HF across different LVH and hs-cTnI groups was assessed using adjusted Cox models. Results: We included 3,796 participants (54 y, 64% women, 17.2% with elevated hs-TnI & 6.1% with LVH) with median follow up of 9.8 y and 285 incident HF events. In adjusted analyses, LVH and higher hs-TnI at baseline were independently associated with risk of HF [HR (95% CI): LVH (vs. no LVH) = 2.2(1.6 - 2.9); Log hs-cTnI (per unit higher)=1.6(1.5 - 1.8)]. A significant interaction was observed between LVH and hs-TnI for the risk of HF (p-int < 0.0001) with the highest risk among individuals with both LVH and elevated hs-TnI [43% incidence, HR (95% CI): 5.7(3.9 - 8.2)]. In contrast, LVH in absence of hs-TnI elevation was not associated with HF risk [ Figure ]. Among 2,367 participants with repeat assessment of hs-TnI at 5 year follow-up, increase in hs-TnI levels on follow-up was also associated with significantly higher risk of HF [HR (95% CI) per 1 unit increase = 1.03 (1.02 - 1.06)] Conclusions: The combination of LVH and elevated hs-TnI levels identifies a malignant preclinical HF phenotype in AAs with a remarkably high absolute risk of HF over a 10-year f/u period. Longitudinal increase in hs-TnI levels is also associated with significant risk of HF. Targeting these high-risk subsets may be an important strategy to mitigate HF risk in blacks.

scholarly journals Cardiac Amyloidosis with Discordant QRS Voltage between Frontal and Precordial Leads

Medicina ◽  
2021 ◽  
Vol 57 (7) ◽  
pp. 660
Author(s):  
Csilla-Andrea Eötvös ◽  
Roxana-Daiana Lazar ◽  
Iulia-Georgiana Zehan ◽  
Erna-Brigitta Lévay-Hail ◽  
Giorgia Pastiu ◽  
...  
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Cardiac Amyloidosis ◽  
Ventricular Hypertrophy ◽  
Low Voltage ◽  
Disease Process ◽  
Left Ventricular ◽  
Clinical Suspicion ◽  
Immunoglobulin Light Chain ◽  
Different Types

Among the different types, immunoglobulin light chain (AL) cardiac amyloidosis is associated with the highest morbidity and mortality. The outcome, however, is significantly better when an early diagnosis is made and treatment initiated promptly. We present a case of cardiac amyloidosis with left ventricular hypertrophy criteria on the electrocardiogram. After 9 months of follow-up, the patient developed low voltage in the limb leads, while still maintaining the Cornell criteria for left ventricular hypertrophy as well. The relative apical sparing by the disease process, as well as decreased cancellation of the opposing left ventricular walls could be responsible for this phenomenon. The discordance between the voltage in the frontal leads and precordial leads, when present in conjunction with other findings, may be helpful in raising the clinical suspicion of cardiac amyloidosis.

scholarly journals Association of Cardiac Injury and Malignant Left Ventricular Hypertrophy With Risk of Heart Failure in African Americans

2019 ◽  
Vol 4 (1) ◽  
pp. 51 ◽  
Author(s):  
Ambarish Pandey ◽  
Neil Keshvani ◽  
Colby Ayers ◽  
Adolfo Correa ◽  
Mark H. Drazner ◽  
...  
Keyword(s):  
Heart Failure ◽  
African Americans ◽  
Left Ventricular Hypertrophy ◽  
Ventricular Hypertrophy ◽  
Cardiac Injury ◽  
Left Ventricular

Abstract P439: Risk Factor Profile and Prevalence of Subclinical Disease in African Americans with Diabetes and Metabolic Syndrome: The Jackson Heart Study

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Kamel A Gharaibeh ◽  
Vanessa Xanthakis ◽  
Jung Hye Sung ◽  
Tandaw S Samdarshi ◽  
Herman A Taylor ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Risk Factor ◽  
African Americans ◽  
Left Ventricular ◽  
Jackson Heart Study ◽  
Cvd Risk ◽  
Metabolic Derangement ◽  
Risk Factor Profile ◽  
Subclinical Disease ◽  
Heart Study

Background . Metabolic derangements such as diabetes (DM) and metabolic syndrome (MetS) are common in African Americans (AA) and contribute to the higher cardiovascular disease (CVD) mortality in this group. A greater prevalence of subclinical disease (ScD) among those with DM and MetS in the AA community may be an explanatory factor. Objective . We assessed the CVD risk factor profile and distribution of ScD among AA with DM and MetS in the Jackson Heart Study (JHS). Methods . We evaluated 4,365 AA participants [mean age (SD) of 53.8 (12.3) years, 64.5% women] free of overt CVD who attended JHS Exam 1 (between 2000- 2004), when ScD assessment was routinely performed(with the exception of CT for coronary calcium that occurred in Exam2). SCD measures included 1) peripheral artery disease (PAD, defined as ankle-brachial index<0.9), 2) high coronary artery calcium (CAC, defined as score>100), 3) left ventricular (LV) hypertrophy (LVH defined as left ventricular mass index>51 g/m 2.7 , 4) low LV ejection fraction (low EF, defined as an EF<50%), and 5) microalbuminuria (MA, defined as an albumin-to-creatinine ratio>25 μg/mg in men and >35 μg/mg in women). We compared the distribution of standard CVD risk factors and ScD prevalence in 1) those without DM or MetS (referent), 2) those with MetS but no DM and 3) those with DM. Results . In our study sample, 1,089 (24.9%) had MetS with no DM and 752 (17.2%) had DM. Compared to the referent group, groups with metabolic derangement tended to be older, female, hypertensive, obese, and had lower HDL, higher fasting glucose, and higher triglycerides levels. Table 1 compares the distribution of ScD for the three groups, and demonstrates the greater odds of. CAC, LVH and microalbuminuria in participants with MetS or DM. Conclusion . In our large community-based sample of AAs, we observed a significantly high prevalence of ScD overall, especially so in participants with MetS and DM. These findings likely contribute to the high CVD rates in AA with MetS and DM. -->

Abstract P159: Coronary Artery Calcium Score Improves the Net Reclassification Index of Prevalent Cardiovascular Disease In African Americans: The Jackson Heart Study

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Joseph Yeboah ◽  
Che L Smith ◽  
Mario Sims ◽  
Ervin Fox ◽  
Yaorong Ge ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Coronary Artery ◽  
High Risk ◽  
African Americans ◽  
Diagnostic Accuracy ◽  
Coronary Artery Calcium ◽  
Smoking Status ◽  
Jackson Heart Study ◽  
Net Reclassification Improvement ◽  
Heart Study

Background: Prior studies suggest that African Americans (AA) have lower prevalence of coronary artery calcium (CAC) compared to whites, yet CAC has similar ability to predict coronary heart disease (CHD) events. The role of CAC as a screening tool for CHD risk in AA is unclear. We compared the diagnostic accuracy for CHD prevalence using the CAC score and the Framingham Risk Score (FRS) in an adult population of AA. Methods: CAC was measured in 2944 participants in the Jackson Heart Study, an NHLBI funded study of AA based in Jackson, MS. Approximately 8% of this cohort had known cardiovascular disease (CVD) defined as prior MI, angina, stroke, PTCA, CABG or PVD. Logistic regression, ROC and net reclassification index (NRI) analysis were used adjusting for age, gender, SBP, total and HDL cholesterol, smoking status, DM and BMI. FRS was calculated and those with DM were classified as high risk. Results: The mean age was 60, 65% were females, 26% had DM, 50% were obese and 30% were current or former smokers. Prevalent CVD was associated with older age, higher SBP, lower HDL and total cholesterol, and higher CAC. CAC was independently associated with prevalent CVD in our multivariable model [OR (95% CI): 1.26 (1.17, 1.35), p< 0.0001]. In ROC analysis, CAC improved the diagnostic accuracy (c statistic) of the FRS from 0.617 to 0.757 (p < 0.0001) for prevalent CVD. The FRS classified 30% of the cohort as high risk, 38.5% as intermediate risk and 31.5% as low risk. FRS classfied 51% of subjects with prevalent CVD as high risk. Addition of CAC to FRS resulted in net reclassification improvement of 4% for subjects with known CVD and 28.5% in those without CVD (see figure). Conclusion: In AA, the CAC is independently associated with prevalent CVD and improves the diagnostic accuracy of FRS for prevalent CVD by 14%. Addition of CAC improves the NRI of those with prevalent CVD by 4% and the NRI of individuals without CVD by 28.5%. Determination of CAC in AA may be useful in identifying individuals at risk of CVD and reclassifying individuals with low and intermediate FRS.

Abstract P012: Hypertension and Alterations in Left Ventricular Geometry in African Americans: The Jackson Heart Study

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Marwah Abdalla ◽  
John N Booth ◽  
Keith M Diaz ◽  
Mario Sims ◽  
Paul Muntner ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
African Americans ◽  
Left Ventricular ◽  
Left Ventricular Geometry ◽  
Jackson Heart Study ◽  
Antihypertensive Medications ◽  
Geometric Patterns ◽  
Ventricular Geometry ◽  
Disease Outcomes ◽  
Heart Study

Introduction: Compared with whites, African Americans (AAs) have a higher risk for hypertension-related cardiovascular disease outcomes, which may be related to alterations in left ventricular geometry. Scarce data exist on how the left ventricle remodels in response to hypertension among AAs. Hypothesis: We hypothesized that among AAs, hypertension will be associated with abnormal echocardiographic–derived left ventricular geometric patterns defined as concentric remodeling (CR), concentric hypertrophy (CH), and eccentric hypertrophy (EH). Methods: We analyzed data from the Jackson Heart Study, a community-based AA cohort who completed a baseline exam that included clinic blood pressure (CBP) and 2D echocardiography (n=5,301). CR, CH, EH, and normal patterns were defined according to left ventricular mass index and relative wall thickness defined using standard American Society of Echocardiography recommendations. The analysis was restricted to 4,572 participants with complete CBP, information on antihypertensive medication, and echocardiographic data. Results: Mean ± SD age was 55.5 ± 12.7 years; 64% were female. Mean ± SD systolic and diastolic CBP was 127 ± 18 and 79 ± 11 mmHg, respectively; 2,785 (61%) of participants had hypertension (CBP ≥140/90 mmHg and/or taking antihypertensive medications). The prevalence of CR, CH, and EH were 10.1%, 5.2%, and 8.2%, respectively. In a multivariable-adjusted model with a normal pattern as the referent group, hypertension was associated with a greater risk of CR, CH, and EH: odds ratio 1.85 (95% confidence interval (CI) 1.43-2.38), 4.16 (95% CI 2.53-6.86), and 1.67 (95% CI: 1.26-2.23) respectively. Among hypertensive participants, older age was significantly associated with CR, CH, and EH after multivariable adjustment. Higher systolic CBP, current smoking and a higher number of classes of antihypertensive medications were additionally significantly associated with CH and EH. Male sex, and heavy and moderate alcohol consumption versus none were also significantly associated with CR. Conclusions: In conclusion, abnormal left ventricular geometry was present in almost 25% of AAs. Hypertension was associated with each abnormal geometric pattern, with approximately a four-fold greater odds for CH. Future studies should examine whether abnormal left ventricular geometric patterns, particularly CH, explains the increased risk of cardiovascular disease outcomes associated with hypertension in AAs.

Risk of ventricular arrhythmias in left ventricular hypertrophy: The Framingham Heart Study

1987 ◽  
Vol 60 (7) ◽  
pp. 560-565 ◽  
Author(s):  
Daniel Levy ◽  
Keaven M. Anderson ◽  
Daniel D. Savage ◽  
Susan A. Balkus ◽  
William B. Kannel ◽  
...  
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Framingham Heart Study ◽  
Ventricular Arrhythmias ◽  
Ventricular Hypertrophy ◽  
Left Ventricular ◽  
Heart Study

Electrocardiographic changes in patients with cardiac rhabdomyomas associated with tuberous sclerosis

2003 ◽  
Vol 13 (3) ◽  
pp. 258-263 ◽  
Author(s):  
Junko Shiono ◽  
Hitoshi Horigome ◽  
Seiyo Yasui ◽  
Tomoyuki Miyamoto ◽  
Miho Takahashi-Igari ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Left Ventricular Hypertrophy ◽  
Tuberous Sclerosis ◽  
Ventricular Hypertrophy ◽  
Left Ventricular ◽  
Cardiac Rhabdomyoma ◽  
Ventricular Cavity ◽  
Electrocardiographic Changes

Background:Cardiac rhabdomyomas associated with tuberous sclerosis induce various abnormalities in the electrocardiogram. Electrocardiographic evidence of ventricular hypertrophy may appear if the tumour is electrically active. To our knowledge, electrocardiographic evidence of ventricular hypertrophy has been reported only in association with congestive heart failure. Follow-up studies of changes in electrocardiographic findings are also lacking.Methods:We studied 21 consecutive patients with cardiac rhabdomyoma associated with tuberous sclerosis, 10 males and 11 females, aged from the date of birth to 9 years at diagnosis. The mean period of follow-up was 53 months. None of the patients developed congestive heart failure. We evaluated the electrocardiographic changes during the follow-up, and their association with echocardiographic findings.Results:Of the 21 patients, 12 showed one or more abnormalities on the electrocardiogram at presentation, with five demonstrating right or left ventricular hypertrophy. In all of these five cases, the tumours were mainly located in the respective ventricular cavity. In one patient with a giant tumour expanding exteriorly, there was marked left ventricular hypertrophy on the electrocardiogram. Followup studies showed spontaneous regression of the tumours in 12 of 19 patients, with abnormalities still present in only 7 patients. A gradual disappearance of left ventricular hypertrophy as seen on the electrocardiogram was noted in the patient with marked left ventricular hypertrophy at presentation in parallel with regression of the tumour.Conclusions:The presence of cardiac rhabdomyomas in patients with tuberous sclerosis might explain the ventricular hypertrophy seen on the electrocardiogram through its electrically active tissue without ventricular pressure overload or ventricular enlargement, although pre-excitation might affect the amplitude of the QRS complex. Even in cases with large tumours, nonetheless, the electric potential might not alter the surface electrocardiogram if the direction of growth of the tumour is towards the ventricular cavity. In many cases, electrocardiographic abnormalities tend to disappear, concomitant with regression of the tumours.

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