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Relations of left ventricular mass to demographic and hemodynamic variables in American Indians: the Strong Heart
R B Devereux1, M J Roman, G de Simone
1Department of Medicine, The New York Hospital-Cornell Medical Center, NY 10021, USA. rbdevere@mail.med.cornell.edu
Insights
Left ventricular mass is best predicted by stroke volume and contractile efficiency, with demographic factors also playing a role. Nearly half of the variability in ventricular mass remains unexplained by these factors.
Area of Science:
- Cardiology
- Physiology
- Biostatistics
Background:
- Previous studies linked left ventricular (LV) mass to demographics and hemodynamics.
- The independent contributions of these factors to LV mass were previously unknown.
Purpose of the Study:
- To determine the relative strength and independence of demographic and hemodynamic predictors of LV mass.
- To identify key factors influencing left ventricular mass.
Main Methods:
- Echocardiography was used to assess LV mass in 1935 American Indian participants.
- Relations between LV mass and demographic variables, blood pressure, stroke volume (SV), and contractility measures were analyzed.
- Multivariate analyses were performed to identify independent correlates of LV mass.
Main Results:
- Stroke volume (SV) and measures of contractility (stress-independent midwall fractional shortening) were stronger predictors of LV mass than systolic blood pressure.
- Demographic variables, including height, weight, and body mass index, were also significant predictors.
- Multivariate models including hemodynamic and demographic factors explained up to 51% of the variability in LV mass.
Conclusions:
- Hemodynamic factors, particularly stroke volume and contractile efficiency, significantly improve the prediction of LV mass compared to blood pressure alone.
- Incorporating demographic variables further enhances LV mass prediction.
- A substantial portion of left ventricular mass variability remains unexplained, suggesting other unmeasured factors are involved.
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 (R(2)=.30 to .44) over the use of systolic blood pressure alone (R(2)=.05), with a further increase in R(2) to .51 when demographic variables are also considered. However, nearly half of the ventricular mass variability remains unexplained.
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