Age-Related Development of Cardiac Remodeling and Dysfunction in Young Black and White Adults: the Coronary Artery Risk Development in Young Adults…

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J Am Soc Echocardiogr. 2020 Nov 16:S0894-7317(20)30718-5. doi: 10.1016/j.echo.2020.11.002. Online ahead of print.

ABSTRACT

BACKGROUND: Little is known about the timing of preclinical heart failure (HF) development, particularly among blacks. The primary aims of this study were to delineate age-related left ventricular (LV) structure and function evolution in a biracial cohort and to test the hypothesis that young-adult LV parameters within normative ranges would be associated with incident stage B-defining LV abnormalities over 25 years, independent of cumulative risk factor burden.

METHODS: We analyzed data from the Coronary Artery Risk Development in Young Adults Study. Participants (N=2,833) were 45% black, 56% female, with mean baseline age 30.1 years. We used generalized estimating equation logistic regression to estimate age-related probabilities of stage B LV abnormalities (remodeling, hypertrophy, or dysfunction) and logistic regression to examine risk-factor-adjusted associations between baseline LV parameters and incident abnormalities. We used Cox regression to assess whether baseline LV parameters associated with incident stage B LV abnormalities were also associated with incident clinical (stage C/D) HF events over >25 years follow-up.

RESULTS: Probabilities of stage B LV abnormalities at ages 25 and 60 years were 10.5% (95% CI, 9.4-11.8%) and 45.0% (42.0-48.1%), with significant race-sex disparities; e.g., at age 60: black men 52.7% (44.9-60.3%), black women 59.4% (53.6-65.0%), white men 39.1% (33.4-45.0%), and white women 39.1% (33.9-44.6%). Over 25 years, baseline LV end-systolic dimension/height was associated with incident systolic dysfunction (adjusted odds ratio per 1-SD higher: 2.56 [1.87-3.52]), eccentric hypertrophy (1.34 [1.02-1.75]), concentric hypertrophy (0.69 [0.51-0.91]), and concentric remodeling (0.68 [0.58-0.79]); baseline LV mass/height2.7 was associated with incident eccentric hypertrophy (1.70 [1.25-2.32]), concentric hypertrophy (1.63 [1.19-2.24]), and diastolic dysfunction (1.24 [1.01-1.52]). Among the entire cohort with baseline echocardiographic data available (N=4097; 72 HF events), LV end-systolic dimension/height and mass/height2.7 were significantly associated with incident clinical HF (adjusted hazard ratios per 1-SD higher: 1.56 [95% CI, 1.26-1.93] and 1.42 [1.14-1.75], respectively).

CONCLUSIONS: Stage B LV abnormalities and related racial disparities were present in young adulthood, increased with age, and were associated with baseline variation in indexed LV end-systolic dimension and mass. Baseline indexed LV end-systolic dimension and mass were also associated with incident clinical HF. Efforts to prevent the LV abnormalities underlying clinical HF should start from a young age.

PMID:33212181 | DOI:10.1016/j.echo.2020.11.002

See original here:
Age-Related Development of Cardiac Remodeling and Dysfunction in Young Black and White Adults: the Coronary Artery Risk Development in Young Adults...