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Diastolic wall strain is associated with incident heart failure in African Americans: Insights from the
Daisuke Kamimura1, Takeki Suzuki1, Michael E Hall2
1Department of Medicine-Cardiology, University of Mississippi Medical Center, Jackson, MS, USA.
Insights
Diastolic wall strain (DWS) can help estimate left ventricular (LV) myocardial stiffness. Lower DWS was linked to a higher risk of heart failure (HF) in African Americans, suggesting DWS as a potential HF predictor.
Area of Science:
- Cardiology
- Echocardiography
- Heart Failure Research
Background:
- Left ventricular (LV) myocardial stiffness is linked to poor LV hemodynamics and heart failure (HF).
- A simple, non-invasive method to assess LV myocardial stiffness is needed.
- Diastolic wall strain (DWS) is an echocardiographic measure of LV myocardial stiffness.
Purpose of the Study:
- To determine if DWS is associated with incident HF.
- To investigate DWS as an estimator of LV myocardial stiffness in African Americans.
Main Methods:
- The Atherosclerosis Risk in Communities Study cohort included 1528 African Americans.
- Participants had preserved LV ejection fraction (≥50%) and no prior cardiovascular disease.
- Follow-up averaged 15.6 years, with 251 incident HF events recorded.
Main Results:
- Lower DWS (higher stiffness) correlated with increased LV mass index, relative wall thickness, and decreased arterial compliance.
- Both continuous and categorical DWS independently predicted incident HF after adjusting for risk factors.
- Individuals in the smallest DWS quintile had a significantly higher risk of HF.
Conclusions:
- DWS is independently associated with an increased risk of incident HF in African Americans.
- DWS shows promise as a qualitative estimator of LV myocardial stiffness.
- This finding may aid in early identification of individuals at risk for heart failure.
Background:
Increased left ventricular (LV) myocardial stiffness may be associated with impaired LV hemodynamics and incident heart failure (HF). However, an indicator that estimates LV myocardial stiffness easily and non-invasively is lacking. The purpose of this study was to determine whether diastolic wall strain (DWS), an echocardiographic estimator of LV myocardial stiffness, is associated with incident HF in a middle-aged community-based cohort of African Americans.
Methods And Results:
We investigated associations between DWS and incident HF among 1528 African Americans (mean age 58.5 years, 66% women) with preserved LV ejection fraction (EF ≥50%) and without a history of cardiovascular disease in the Atherosclerosis Risk in Communities Study. Participants with the smallest DWS quintile (more LV myocardial stiffness) had a higher LV mass index, higher relative wall thickness, and lower arterial compliance than those in the larger four DWS quintiles (p<0.01 for all). Over a mean follow-up of 15.6 years, there were 251 incident HF events (incidence rate: 10.9 per 1000 person-years). After adjustment for traditional risk factors and incident coronary artery disease, both continuous and categorical DWS were independently associated with incident HF (HR 1.21, 95%CI 1.04-1.41 for 0.1 decrease in continuous DWS, p=0.014, HR 1.40, 95%CI 1.05-1.87 for the smallest DWS quintile vs other combined quintiles, p=0.022).
Conclusions:
DWS was independently associated with an increased risk of incident HF in a community-based cohort of African Americans. DWS could be used as a qualitative estimator of LV myocardial stiffness.
