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Injury, Hypertrophy, HF Risk in African Americans
Study Questions:
Can subclinical myocardial injury and left ventricular hypertrophy (LVH) predict African Americans who are at risk for heart failure (HF)?
Methods:
The study group was compromised of 3,987 participants (64% women) in the Jackson Heart Study (JHS), a community-based, prospective, observational cohort of African Americans without known coronary heart disease or HF. Echocardiograms and plasma samples used for high-sensitivity cardiac troponin I (hs-cTnI) assays were obtained at baseline visit between 2000-2004. The primary outcome of interest was incidence of HF hospitalization, which was determined through an established adjudication protocol. Adjusted associations were assessed between three categories of subclinical myocardial injury (none, mild, moderate-severe), LVH, and risk of incident HF.
Results:
The prevalence of baseline LVH was 6%, and the prevalence of any subclinical myocardial injury (hs-cTnI ≥6 ng/L in men, ≥4 ng/L in women) was 25.1%; 3.7% (145) had both. Participants with either subclinical myocardial injury or LVH were more likely to have risk factors such as diabetes and hypertension. Incidence of HF was significantly associated with LVH and elevated hs-cTnI (dose-dependent manner). Those with both LVH and subclinical myocardial injury had a 10-fold unadjusted incidence of HF; participants with LVH had a 3.5-fold higher risk of HF if subclinical myocardial injury was also present. In multivariate analysis, the combination of LVH and subclinical myocardial injury resulted in a greater than 5-fold risk of incident HF. Men with both LVH and subclinical myocardial injury at baseline had approximately 15-fold increased risk of HF compared to those with neither; women with both had an approximate 4-fold increased risk.
Conclusions:
The presence of LVH and subclinical myocardial injury, especially in men, prognosticates a high risk of incident HF.
Perspective:
HF affects African Americans more than any other racial group; the higher prevalence has been attributed to higher rates of diabetes, hypertension, and LVH. Biomarkers for subclinical cardiac injury have been shown to be associated with increased risk for HF. The JHS has reported that over 60% of all HF events occurred in the 25% with any subclinical myocardial injury. This study by Pandey et al. provides further evidence that the combination of LVH and elevated hs-cTnI level identifies a very high-risk group for HF.
Further study is needed on: 1) the impact of type of HF (preserved vs. reduced ejection fraction) and the progression (or regression) of LVH on outcomes; 2) potential of LVH on the electrocardiogram (ECG), instead of echocardiogram, combined with the hs-cTnI assay as a practical screening tool; and 3) the applicability of the findings of this study to other at-risk groups for HF and sudden cardiac death.
Clinical Topics: Heart Failure and Cardiomyopathies, Noninvasive Imaging, Prevention, Acute Heart Failure, Heart Failure and Cardiac Biomarkers, Echocardiography/Ultrasound, Hypertension
Keywords: African Americans, Biomarkers, Diabetes Mellitus, Echocardiography, Heart Failure, Hypertension, Hypertrophy, Left Ventricular, Primary Prevention, Risk Factors, Troponin I
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