Race-Related Differences in Left Ventricular Structural and Functional Remodeling in Response to Increased Afterload:
Miguel M Fernandes-Silva1, Amil M Shah1, Sheila Hegde1
1Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.
JACC. Heart Failure
|December 27, 2016
Summary
Black Americans show higher arterial elastance (Ea), indicating greater left ventricular afterload. This heightened Ea is linked to adverse cardiac remodeling and may explain increased heart failure risk in this population.
Area of Science:
- Cardiology
- Cardiovascular Research
- Health Disparities
Background:
- Racial disparities in heart failure prevalence are known, but underlying mechanisms require clarification.
- Arterial afterload, reflected by arterial elastance (Ea), is a key factor in left ventricular (LV) remodeling and dysfunction.
- Understanding racial differences in Ea is crucial for addressing heart failure risk.
Purpose of the Study:
- To investigate racial variations in arterial elastance (Ea) and its association with cardiac structure and function.
- To test the hypothesis that the left ventricle in Black individuals exhibits greater afterload sensitivity than in White individuals.
Main Methods:
- Analysis of 5,727 community-based participants from the Atherosclerosis Risk In Community (ARIC) study.
- Echocardiography data collected between 2011 and 2013, with 22% of participants identifying as Black.
- Statistical adjustments for baseline differences in age, sex, obesity, hypertension, and diabetes.
Main Results:
- After adjusting for baseline characteristics, Black participants had higher arterial elastance (Ea) compared to White participants.
- In Black individuals, higher Ea was significantly associated with increased left ventricular (LV) remodeling and elevated LV filling pressures.
- These associations between Ea and LV remodeling/filling pressures were not observed in White individuals, indicating a significant interaction effect.
Conclusions:
- Black Americans demonstrate heightened afterload sensitivity, as evidenced by higher Ea.
- This increased sensitivity contributes to left ventricular (LV) structural and functional remodeling.
- The findings suggest a potential mechanism underlying the greater risk of heart failure observed in Black Americans compared to White Americans.
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