Association of Cardiac Injury and Malignant Left Ventricular Hypertrophy with Risk of Heart Failure in African Americans

The Jackson Heart Study

Ambarish Pandey, Neil Keshvani, Colby Ayers, Adolfo Correa, Mark H Drazner, Alana Lewis, Carlos J. Rodriguez, Michael E. Hall, Ervin R. Fox, Robert J. Mentz, Christopher Defilippi, Stephen L. Seliger, Christie M. Ballantyne, Ian J Neeland, James A de Lemos, Jarett D Berry

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Importance: African Americans have a higher burden of heart failure (HF) risk factors and clinical HF than other racial/ethnic groups. However, the factors underlying the transition from at-risk to clinical HF in African Americans are not well understood. Objective: To evaluate the contributions of left ventricular hypertrophy (LVH) and subclinical myocardial injury as determined by abnormal high-sensitivity cardiac troponin-I (hs-cTnI) measurements toward HF risk among African Americans. Design, Setting, and Participants: This prospective, community-based cohort study was conducted between July 2016 and September 2018 and included African American participants from Jackson, Mississippi enrolled in the Jackson Heart Study without prevalent HF who had hs-cTnI measurements and an echocardiographic examination at baseline. Participants were stratified into categories based on the presence or absence of LVH and subclinical myocardial injury (category 1: hs-cTnI < 4 ng/L in women and <6 ng/L in men; category 2: 4-10 ng/L in women and 6-12 ng/L in men; category 3: >10 ng/L in women and >12 ng/L in men). Main Outcomes and Measures: Adjusted associations between LVH, subclinical myocardial injury, and the risk of incident HF hospitalization were assessed using Cox proportional hazards models. Results: The study included 3987 participants (2552 women [64%]; 240 (6.0%) with LVH; 1003 (25.1%) with myocardial injury) with 285 incident HF events over a median follow-up of 9.8 years (interquartile range, 8.9-10.6 years). In adjusted analyses, higher LV mass and subclinical myocardial injury were independently associated with the risk of HF with a significant interaction between the 2 (Pint < 0.001). The highest risk of HF was noted among individuals with both LVH and myocardial injury (absolute incidence, 35%; adjusted hazard ratio [aHR; vs no LVH and no myocardial injury], 5.35; 95% CI, 3.66-7.83). A significant interaction by sex was also observed. Men with LVH and subclinical myocardial injury had an almost 15-fold higher risk of HF (aHR, 14.62; 95% CI, 7.61-28.10) vs those with neither LVH nor injuries. By contrast, women with this phenotype had a nearly 4-fold higher risk of HF (aHR, 3.81; 95% CI, 2.40-6.85). Conclusions and Relevance: The combination of LVH and subclinical myocardial injury identifies a malignant, preclinical HF phenotype in African Americans with a very high risk of HF, particularly among men. This finding could have implications for future screening strategies that are designed to prevent HF in the population..

Original languageEnglish (US)
JournalJAMA Cardiology
DOIs
StateAccepted/In press - Jan 1 2018

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Left Ventricular Hypertrophy
African Americans
Heart Failure
Wounds and Injuries
Troponin I
Phenotype
Mississippi
Proportional Hazards Models
Ethnic Groups
Hospitalization
Cohort Studies

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Association of Cardiac Injury and Malignant Left Ventricular Hypertrophy with Risk of Heart Failure in African Americans : The Jackson Heart Study. / Pandey, Ambarish; Keshvani, Neil; Ayers, Colby; Correa, Adolfo; Drazner, Mark H; Lewis, Alana; Rodriguez, Carlos J.; Hall, Michael E.; Fox, Ervin R.; Mentz, Robert J.; Defilippi, Christopher; Seliger, Stephen L.; Ballantyne, Christie M.; Neeland, Ian J; de Lemos, James A; Berry, Jarett D.

In: JAMA Cardiology, 01.01.2018.

Research output: Contribution to journalArticle

Pandey, Ambarish ; Keshvani, Neil ; Ayers, Colby ; Correa, Adolfo ; Drazner, Mark H ; Lewis, Alana ; Rodriguez, Carlos J. ; Hall, Michael E. ; Fox, Ervin R. ; Mentz, Robert J. ; Defilippi, Christopher ; Seliger, Stephen L. ; Ballantyne, Christie M. ; Neeland, Ian J ; de Lemos, James A ; Berry, Jarett D. / Association of Cardiac Injury and Malignant Left Ventricular Hypertrophy with Risk of Heart Failure in African Americans : The Jackson Heart Study. In: JAMA Cardiology. 2018.
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title = "Association of Cardiac Injury and Malignant Left Ventricular Hypertrophy with Risk of Heart Failure in African Americans: The Jackson Heart Study",
abstract = "Importance: African Americans have a higher burden of heart failure (HF) risk factors and clinical HF than other racial/ethnic groups. However, the factors underlying the transition from at-risk to clinical HF in African Americans are not well understood. Objective: To evaluate the contributions of left ventricular hypertrophy (LVH) and subclinical myocardial injury as determined by abnormal high-sensitivity cardiac troponin-I (hs-cTnI) measurements toward HF risk among African Americans. Design, Setting, and Participants: This prospective, community-based cohort study was conducted between July 2016 and September 2018 and included African American participants from Jackson, Mississippi enrolled in the Jackson Heart Study without prevalent HF who had hs-cTnI measurements and an echocardiographic examination at baseline. Participants were stratified into categories based on the presence or absence of LVH and subclinical myocardial injury (category 1: hs-cTnI < 4 ng/L in women and <6 ng/L in men; category 2: 4-10 ng/L in women and 6-12 ng/L in men; category 3: >10 ng/L in women and >12 ng/L in men). Main Outcomes and Measures: Adjusted associations between LVH, subclinical myocardial injury, and the risk of incident HF hospitalization were assessed using Cox proportional hazards models. Results: The study included 3987 participants (2552 women [64{\%}]; 240 (6.0{\%}) with LVH; 1003 (25.1{\%}) with myocardial injury) with 285 incident HF events over a median follow-up of 9.8 years (interquartile range, 8.9-10.6 years). In adjusted analyses, higher LV mass and subclinical myocardial injury were independently associated with the risk of HF with a significant interaction between the 2 (Pint < 0.001). The highest risk of HF was noted among individuals with both LVH and myocardial injury (absolute incidence, 35{\%}; adjusted hazard ratio [aHR; vs no LVH and no myocardial injury], 5.35; 95{\%} CI, 3.66-7.83). A significant interaction by sex was also observed. Men with LVH and subclinical myocardial injury had an almost 15-fold higher risk of HF (aHR, 14.62; 95{\%} CI, 7.61-28.10) vs those with neither LVH nor injuries. By contrast, women with this phenotype had a nearly 4-fold higher risk of HF (aHR, 3.81; 95{\%} CI, 2.40-6.85). Conclusions and Relevance: The combination of LVH and subclinical myocardial injury identifies a malignant, preclinical HF phenotype in African Americans with a very high risk of HF, particularly among men. This finding could have implications for future screening strategies that are designed to prevent HF in the population..",
author = "Ambarish Pandey and Neil Keshvani and Colby Ayers and Adolfo Correa and Drazner, {Mark H} and Alana Lewis and Rodriguez, {Carlos J.} and Hall, {Michael E.} and Fox, {Ervin R.} and Mentz, {Robert J.} and Christopher Defilippi and Seliger, {Stephen L.} and Ballantyne, {Christie M.} and Neeland, {Ian J} and {de Lemos}, {James A} and Berry, {Jarett D}",
year = "2018",
month = "1",
day = "1",
doi = "10.1001/jamacardio.2018.4300",
language = "English (US)",
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T1 - Association of Cardiac Injury and Malignant Left Ventricular Hypertrophy with Risk of Heart Failure in African Americans

T2 - The Jackson Heart Study

AU - Pandey, Ambarish

AU - Keshvani, Neil

AU - Ayers, Colby

AU - Correa, Adolfo

AU - Drazner, Mark H

AU - Lewis, Alana

AU - Rodriguez, Carlos J.

AU - Hall, Michael E.

AU - Fox, Ervin R.

AU - Mentz, Robert J.

AU - Defilippi, Christopher

AU - Seliger, Stephen L.

AU - Ballantyne, Christie M.

AU - Neeland, Ian J

AU - de Lemos, James A

AU - Berry, Jarett D

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Importance: African Americans have a higher burden of heart failure (HF) risk factors and clinical HF than other racial/ethnic groups. However, the factors underlying the transition from at-risk to clinical HF in African Americans are not well understood. Objective: To evaluate the contributions of left ventricular hypertrophy (LVH) and subclinical myocardial injury as determined by abnormal high-sensitivity cardiac troponin-I (hs-cTnI) measurements toward HF risk among African Americans. Design, Setting, and Participants: This prospective, community-based cohort study was conducted between July 2016 and September 2018 and included African American participants from Jackson, Mississippi enrolled in the Jackson Heart Study without prevalent HF who had hs-cTnI measurements and an echocardiographic examination at baseline. Participants were stratified into categories based on the presence or absence of LVH and subclinical myocardial injury (category 1: hs-cTnI < 4 ng/L in women and <6 ng/L in men; category 2: 4-10 ng/L in women and 6-12 ng/L in men; category 3: >10 ng/L in women and >12 ng/L in men). Main Outcomes and Measures: Adjusted associations between LVH, subclinical myocardial injury, and the risk of incident HF hospitalization were assessed using Cox proportional hazards models. Results: The study included 3987 participants (2552 women [64%]; 240 (6.0%) with LVH; 1003 (25.1%) with myocardial injury) with 285 incident HF events over a median follow-up of 9.8 years (interquartile range, 8.9-10.6 years). In adjusted analyses, higher LV mass and subclinical myocardial injury were independently associated with the risk of HF with a significant interaction between the 2 (Pint < 0.001). The highest risk of HF was noted among individuals with both LVH and myocardial injury (absolute incidence, 35%; adjusted hazard ratio [aHR; vs no LVH and no myocardial injury], 5.35; 95% CI, 3.66-7.83). A significant interaction by sex was also observed. Men with LVH and subclinical myocardial injury had an almost 15-fold higher risk of HF (aHR, 14.62; 95% CI, 7.61-28.10) vs those with neither LVH nor injuries. By contrast, women with this phenotype had a nearly 4-fold higher risk of HF (aHR, 3.81; 95% CI, 2.40-6.85). Conclusions and Relevance: The combination of LVH and subclinical myocardial injury identifies a malignant, preclinical HF phenotype in African Americans with a very high risk of HF, particularly among men. This finding could have implications for future screening strategies that are designed to prevent HF in the population..

AB - Importance: African Americans have a higher burden of heart failure (HF) risk factors and clinical HF than other racial/ethnic groups. However, the factors underlying the transition from at-risk to clinical HF in African Americans are not well understood. Objective: To evaluate the contributions of left ventricular hypertrophy (LVH) and subclinical myocardial injury as determined by abnormal high-sensitivity cardiac troponin-I (hs-cTnI) measurements toward HF risk among African Americans. Design, Setting, and Participants: This prospective, community-based cohort study was conducted between July 2016 and September 2018 and included African American participants from Jackson, Mississippi enrolled in the Jackson Heart Study without prevalent HF who had hs-cTnI measurements and an echocardiographic examination at baseline. Participants were stratified into categories based on the presence or absence of LVH and subclinical myocardial injury (category 1: hs-cTnI < 4 ng/L in women and <6 ng/L in men; category 2: 4-10 ng/L in women and 6-12 ng/L in men; category 3: >10 ng/L in women and >12 ng/L in men). Main Outcomes and Measures: Adjusted associations between LVH, subclinical myocardial injury, and the risk of incident HF hospitalization were assessed using Cox proportional hazards models. Results: The study included 3987 participants (2552 women [64%]; 240 (6.0%) with LVH; 1003 (25.1%) with myocardial injury) with 285 incident HF events over a median follow-up of 9.8 years (interquartile range, 8.9-10.6 years). In adjusted analyses, higher LV mass and subclinical myocardial injury were independently associated with the risk of HF with a significant interaction between the 2 (Pint < 0.001). The highest risk of HF was noted among individuals with both LVH and myocardial injury (absolute incidence, 35%; adjusted hazard ratio [aHR; vs no LVH and no myocardial injury], 5.35; 95% CI, 3.66-7.83). A significant interaction by sex was also observed. Men with LVH and subclinical myocardial injury had an almost 15-fold higher risk of HF (aHR, 14.62; 95% CI, 7.61-28.10) vs those with neither LVH nor injuries. By contrast, women with this phenotype had a nearly 4-fold higher risk of HF (aHR, 3.81; 95% CI, 2.40-6.85). Conclusions and Relevance: The combination of LVH and subclinical myocardial injury identifies a malignant, preclinical HF phenotype in African Americans with a very high risk of HF, particularly among men. This finding could have implications for future screening strategies that are designed to prevent HF in the population..

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