Left ventricular mass and ventricular remodeling among Hispanic subgroups compared with non-Hispanic blacks and whites: MESA (Multi-ethnic Study of Atherosclerosis)

Abstract

Objectives: The purpose of this study was to examine the prevalence of left ventricular hypertrophy (LVH) and left ventricular (LV) remodeling patterns within Hispanic subgroups compared with non-Hispanic whites in the MESA (Multi-Ethnic Study of Atherosclerosis).

Background: Hispanics are the largest and fastest-growing ethnic minority in the U.S., but there are no data on LVH and LV geometry among Hispanic subgroups.

Methods: Cardiac magnetic resonance imaging was performed in 4,309 men and women age 45 to 84 years without clinical cardiovascular disease. Hispanics were categorized into subgroups based on self-reported ancestry. LVH was defined as the upper 95th percentile of indexed LV mass in a reference normotensive, nondiabetic, nonobese population, and LV remodeling according to the presence/absence of LVH and abnormal/normal LV mass to LV end-diastolic volume ratio.

Results: Among Hispanic participants, 574 were of Mexican origin, 329 were of Caribbean origin, and 161 were of Central/South American origin. On unadjusted analysis, only Caribbean-origin Hispanics (prevalence ratio = 1.2; 95% confidence interval [CI]: 1.03 to 1.4) had greater prevalence of hypertension than non-Hispanic whites. Hispanic subgroups were more likely to have LVH than non-Hispanic whites after adjustment for hypertension and other covariates (Caribbean-origin Hispanics = odds ratio [OR]: 1.8, 95% CI: 1.1 to 3.0; Mexican-origin Hispanics = OR: 2.2, 95% CI: 1.4 to 3.3; Central/South Americans = OR: 1.5, 95% CI: 0.7 to 3.1). All Hispanic subgroups also had a higher prevalence of concentric and eccentric hypertrophy compared with non-Hispanic whites (p < 0.001).

Conclusions: Caribbean-origin Hispanics had a higher prevalence of LVH and abnormal LV remodeling compared with non-Hispanic whites. A higher prevalence of LVH and abnormal LV remodeling was also observed among Mexican-origin Hispanics, despite a lower prevalence of hypertension. Differences among Hispanic subgroups regarding LVH and LV remodeling should be taken into account when evaluating cardiovascular risk in this population.

Figure 1. Diagram of left ventricular remodeling patterns based on left ventricular hypertrophy and left ventricular Mass

Cavity ratio--Four types of left ventricular (LV) remodeling patterns are described based on presence/absence of LV hypertrophy (LVH) and the LV Mass/LV end-diastolic volume (M-C) ratio: normal with LVH absent and normal M-C ratio, concentric remodeling with LVH absent and increased M-C ratio, eccentric hypertrophy with LVH present and normal M-C ratio, and concentric hypertrophy with LVH present and increased M-C ratio. Partition value for elevated M-C ratio was 2.0.

Figure 2. Prevalence of Left Ventricular Hypertrophy and elevated Mass-Cavity ratio by Race

Ethnicity and Hispanic Subgroup--Different indexing methodologies for left ventricular hypertrophy (LVH) are presented including percent-predicted (LVH-MESA) and body surface area (LVH-BSA). M-C ratio = LVM/LV end-diastolic volume; partition value for elevated M-C ratio was 2.0.

Figure 3. Left ventricular mass difference in means from non-Hispanic whites

Multivariate regression modeling of left ventricular mass percent predicted as a continuous variable by Race-Ethnicity and Hispanic Subgroups

Figure 4. Percent Breakdown of Four left ventricular remodeling patterns across Race

Ethnicity and Hispanic Subgroup—Prevalence of abnormal remodeling patterns is higher among Hispanic subgroups compared to non-Hispanic whites (differences were significant at the p<0.0001 level).