Optimal threshold value for left ventricular hypertrophy in blacks: the Atherosclerosis Risk in Communities study

Area of Science:

• Cardiology
• Medical Imaging
• Epidemiology

Background:

• Echocardiographic left ventricular (LV) mass distribution varies significantly across ethnic groups.
• Established criteria for diagnosing left ventricular hypertrophy (LVH) are primarily based on white populations, potentially leading to misdiagnosis in other ethnicities.
• Black individuals exhibit a higher prevalence of LVH, necessitating ethnic-specific diagnostic thresholds.

Purpose of the Study:

• To determine if echocardiographic criteria for LVH derived from white populations are applicable to Black individuals.
• To establish optimal LVH threshold values for LV mass index (LVMI) in a Black cohort.
• To assess the predictive value of LVH thresholds for incident cardiovascular disease (CVD).

Main Methods:

• Echocardiographic LV mass was measured in 1616 Black participants (Atherosclerosis Risk in Communities study, Jackson, MS).
• Optimal LVH threshold was identified using receiver-operating characteristic (ROC) curve analysis, probability values, and general additive model (GAM) plots.
• Participants were followed for incident CVD (coronary heart disease, stroke, congestive heart failure) over a median of 6.8 years.

Main Results:

• The optimal LVH threshold identified by ROC analysis was 51.2 g/m(2.7).
• Cox and GAM models indicated an optimal threshold of 50 to 51 g/m(2.7) for LVH in middle-aged Black adults.
• These thresholds closely align with the 51 g/m(2.7) criterion established for white populations.

Conclusions:

• The established echocardiographic threshold for LVH of 51 g/m(2.7) is appropriate for use in Black adults.
• This finding supports the use of a universal echocardiographic criterion for LVH across different ethnic groups.
• Accurate LVH assessment is crucial for identifying cardiovascular disease risk in diverse populations.