(Circulation. 1997;96:1416-1423.)
© 1997 American Heart Association, Inc.
Articles |
Relations of Left Ventricular Mass to Demographic and Hemodynamic Variables in American Indians
The Strong Heart Study
From the Department of Medicine, The New York (NY) Hospital–Cornell Medical Center (R.B.D., M.J.R., G. de S., M.J.O., M.P.); the Medlantic Research Institute, Washington, DC (B.V.H.); the University of Oklahoma School of Public Health Sciences, Oklahoma City (J.Y.); and the Division of Epidemiology and Disease Control, NHLBI, Bethesda, Md (R.R.F.).
Correspondence to Richard B. Devereux, MD, Division of Cardiology, Box 222, The New York Hospital–Cornell Medical Center, 525 E 68th St, New York, NY 10021. E-mail rbdevere{at}mail.med.cornell.edu
Background Previous studies have identified associations of left ventricular (LV) mass with demographic (body habitus and sex) and hemodynamic variables (blood pressure, stroke volume [SV], and myocardial contractility), but the relative strength and independence of these associations remain unknown.
Methods and Results We examined the relations of echocardiographically determined LV mass to demographic variables, blood pressure, Doppler SV, and measures of contractility (end-systolic stress [ESS]/end-systolic volume index and midwall fractional shortening [MFS] as a percentage of predicted for circumferential end-systolic stress [stress-independent shortening]) in 1935 American Indian participants in the Strong Heart Study phase 2 examination without mitral regurgitation or segmental wall motion abnormalities. Weak positive relations of LV mass with systolic and diastolic pressures (r=.22 and r=.20) were exceeded by positive relations with height (r=.30), weight (r=.47), body mass index (r=.31), body surface area (r=.49), and Doppler SV (r=.50) and negative relations with ESS/volume index ratios (r=-.33 and -.29) and stress-independent MFS (r=-.26, all P<.0001). In multivariate analyses that included blood pressure, SV, and a different contractility measure in each model, systolic pressure, stroke volume, and the contractility measure were independent correlates of LV mass (multiple R=.60 to .66, all P<.0001). When demographic variables were added, LV mass was more strongly predicted by higher SV and lower afterload-independent MFS than by greater systolic pressure, height, and body mass index (each P<.00001, multiple R=.71).
Conclusions Additional characterization of volume load and contractile efficiency improves hemodynamic prediction of LV mass (R2=.30 to .44) over the use of systolic blood pressure alone (R2=.05), with a further increase in R2 to .51 when demographic variables are also considered. However, nearly half of the ventricular mass variability remains unexplained.
Key Words: blood pressure • contractility • ventricles • echocardiography
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