Author + information
- Received September 26, 2016
- Revision received October 5, 2016
- Accepted October 10, 2016
- Published online February 27, 2017.
- Miguel M. Fernandes-Silva, MD, PhDa,
- Amil M. Shah, MD, MPHa,
- Sheila Hegde, MDa,
- Alexandra Goncalves, MD, PhDa,b,
- Brian Claggett, PhDa,
- Susan Cheng, MD, MPHa,
- Wilson Nadruz, MD, PhDa,
- Dalane W. Kitzman, MDc,
- Suma H. Konety, MD, MSd,
- Kunihiro Matsushita, MDe,
- Thomas Mosley, PhDf,
- Carolyn S.P. Lam, MDg,h,
- Barry A. Borlaug, MDi and
- Scott D. Solomon, MDa,∗ ()
- aCardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts
- bUniversity of Porto Medical School, Porto, Portugal
- cWake Forest University School of Medicine, Winston-Salem, North Carolina
- dUniversity of Minnesota, Minneapolis, Minnesota
- eJohns Hopkins University, Baltimore, Maryland
- fUniversity of Mississippi Medical Center, Jackson, Mississippi
- gNational Heart Centre Singapore, Singapore, Singapore
- hDuke-National University of Singapore Medical School, Singapore, Singapore
- iMayo Clinic College of Medicine, Rochester, Minnesota
- ↵∗Address for correspondence:
Dr. Scott D. Solomon, Brigham and Women’s Hospital, Cardiovascular Division, 75 Francis Street, Boston, Massachusetts 02115.
Objectives The aim of this study was to evaluate racial differences in arterial elastance (Ea), which reflects the arterial afterload faced by the left ventricle, and its associations with cardiac structure and function. The hypothesis under study was that the left ventricle in blacks displays heightened afterload sensitivity compared with whites.
Background Chronic increasing in arterial afterload may be an important trigger for left ventricular (LV) remodeling and dysfunction that lead to heart failure. Racial differences in the predisposition to heart failure are well described, but the underlying mechanisms remain unclear.
Methods In total, 5,727 community-based, older ARIC (Atherosclerosis Risk In Community) study participants (22% black) who underwent echocardiography between 2011 and 2013 were studied.
Results Blacks were younger (mean age 75 ± 5 years vs. 76 ± 5 years), were more frequently female (66% vs. 57%), and had higher prevalence rates 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 mm Hg/ml vs. 1.80 ± 0.01 mm Hg/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).
Conclusions 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 for heart failure compared with white Americans.
The ARIC study is carried out as a collaborative study supported by National Heart, Lung, and Blood Institute (NHLBI) contracts (HHSN268201100005C, HHSN268201100006C, HHSN268201100007C, HHSN268201100008C, HHSN268201100009C, HHSN268201100010C, HHSN268201100011C, and HHSN268201100012C). This work was also supported by NHLBI cooperative agreement NHLBI-HC-11-08 (to Dr. Solomon), grants R00-HL-107642 (to Dr. Cheng) and K08-HL-116792 (to Dr. Shah); American Heart Association grant 14CRP20380422 (to Dr. Shah); a grant from the Ellison Foundation (to Dr. Cheng); and National Institutes of Health grant T32 HL094301-06 (to Dr. Hegde). Dr. Goncalves was supported by Portuguese Foundation for Science and Technology grant HMSP-ICS/007/2012. Dr. Nadruz was supported by Brazilian National Council for Scientific and Technological Development grant 249481/2013-8. Dr. Fernandes-Silva was supported by the Lemann Foundation. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 26, 2016.
- Revision received October 5, 2016.
- Accepted October 10, 2016.
- 2017 American College of Cardiology Foundation