(Hypertension. 1997;29:1095-1103.)
© 1997 American Heart Association, Inc.
Articles |
Left Ventricular Mass in the Elderly
The Cardiovascular Health Study
From the Division of Cardiology, Department of Medicine, University of California, Irvine (J.M.G., N.D.W.); Cardiovascular Health Study Coordinating Center, University of Washington, Seattle (A.A., R.K.); Cardiology Division, Department of Medicine, Georgetown University Medical School, Washington, DC (J.S.G.); Departments of Medicine and Epidemiology, The Johns Hopkins Medical Institutions, Baltimore, Md (L.P.F.); Division of Cardiology, Department of Medicine, Bowman Gray School of Medicine, Winston-Salem, NC (H.S.K.); Department of Radiology, Geisinger Medical Center, Danville, Pa (D.H.O'L.); and Department of Pathology, University of Vermont, Colchester (R.T.).
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Abstract |
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Abstract Left ventricular (LV) mass, as estimated from M-mode echocardiography (echo), has previously been shown to be an independent predictor of incident cardiovascular disease morbidity and mortality. We evaluated the relationship at baseline of echo LV mass to relevant cardiovascular disease risk factors and other potential covariates in the Cardiovascular Health Study, multicenter study sponsored by the National Heart, Lung, and Blood Institute of 5201 men and women aged 65 years or older (mean, 73). Two-dimensionally directed M-mode echo LV mass measurements could be obtained in 1357 men and 2053 women (66% of this elderly cohort). Stepwise linear regression analyses of the relationship of echo LV mass to demographic and risk factor, physical activity, electrocardiographic, and prevalent disease variables resulted in a model that explained 37% of the variance for the entire cohort. In order of decreasing importance, factors positively associated with echo LV mass were body weight, male sex, systolic pressure, presence of congestive heart failure, present smoking, major and minor electrocardiographic abnormalities, treatment for hypertension, valvular heart disease, aortic regurgitation by color Doppler, and mitral regurgitation by color Doppler (in men) whereas diastolic pressure, bioresistance (a measure of adiposity), and high-density lipoprotein cholesterol were inversely related to echo LV mass. Although height and weight were both related to LV mass, height added nothing once weight was entered in multiple linear regression analyses. Furthermore, in the multiple regression models, diastolic pressure was inversely and systolic BP positively related to LV mass, with similar magnitudes for their coefficients. In consonance with these findings, pulse pressure was positively related to LV mass in bivariate analyses. Multiple linear regression analyses explained less of the variance for ventricular septal thickness (R2=.13) and LV posterior wall thickness (R2=.14) than for LV mass (R2=.37) and LV diastolic dimension (R2=.27). Intriguing findings in the elderly Cardiovascular Health Study cohort included the presence of pulse pressure as a positive correlate, and high-density lipoprotein cholesterol as an inverse correlate, of LV mass. Longitudinal studies in the Cardiovascular Health Study cohort will help to clarify the importance of demographic, risk factor, and other variables, and changes in these variables, in predicting changes in echo LV mass and its components as well as the prognostic significance of LV mass in the elderly.
Key Words: ventricular function, left • echocardiography • risk factors • blood pressure
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Introduction |
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Epidemiological data from the Framingham Heart Study indicate that LV hypertrophy, as measured by M-mode echocardiography (echo), is an independent predictor of mortality and morbidity from CHD during a 4-year follow-up period.1 2 After adjustment for age, diastolic BP, pulse pressure, treatment for hypertension, cigarette smoking, diabetes, obesity, and the ratio of total cholesterol to HDL cholesterol, LV mass divided by height was associated with a mean relative risk of 1.73 in men and 2.12 in women for incidence of death from cardiovascular disease. However, echo data have not been available from large multicenter, population-based studies of the free-living elderly. Furthermore, although previous studies have emphasized the important predictive value of echo LV mass for CHD mortality and morbidity, there is a paucity of published information in the elderly relating LV mass to potential explanatory factors.
Recent baseline echo data from the CHS have revealed that after adjustment for weight, BP, and other covariates, M-mode (two-dimensionally directed) LV mass is significantly higher in elderly men than elderly women, regardless of the presence of clinical heart disease (both P<.001).3 In addition, a weak relationship between age and M-mode LV mass was detected. The purpose of this report is to extend these findings by describing cross-sectional associations of baseline cardiovascular disease risk factors and other covariates with CHS baseline M-mode echo LV mass and its component variables.
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Methods |
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Subjects
CHS is a prospective, population-based study of 5201 participants (2246 men and 2955 women) aged 65 years and older. Of this cohort, 4850 participants were white, 307 were black, and 44 were classified as "other non-white." Ages ranged from 65 to 100 years in both men and women (mean±SD, 73.3±5.8 in men and 72.4±5.4 in women). CHS participants were recruited and examined at four Field Centers: Forsyth County, NC; Sacramento County, Calif; Allegheny County, Pa; and Washington County, Md. The overall design, objectives, and recruitment strategy of CHS and characteristics of the cohort recruited have been presented in detail elsewhere.4 5
Echocardiography Performance and
Reading Protocol
Echocardiography was performed during a CHS
examination that included, as previously described,4
interviews related to medical history, physical activity, personal
habits, cognitive function, and dietary intake; anthropometry;
recumbent, sitting, and standing BP; resting and ambulatory ECG;
spirometry; carotid ultrasound; and laboratory studies. The design of
the echo protocol used in CHS has been described in detail
elsewhere.6 Briefly, for each subject, a baseline echo was
recorded onto super-VHS tape using a standardized protocol.
Measurements were made at the Echocardiography
Reading Center at the University of California, Irvine, from digitized
images using an off-line image-analysis system equipped with
customized computer algorithms. Quality-control measures included
standardized training of echo technicians and readers, periodic
technician observation by a trained echocardiographer,
blind duplicate readings to establish interreader and intrareader
measurement variabilities, periodic reader review sessions, phantom
studies on the ultrasound equipment, and quality-control audits.
Echocardiography Measurements
This report focuses on two-dimensionally directed M-mode
measurements of LV mass and its three component variables:
ventricular septal thickness at end diastole
(VSTd), LV (internal) dimension at end diastole (LVIDd),
and LV posterior wall thickness at end diastole (PWTd).
M-mode measurements were made according to conventions established by
the American Society of
Echocardiography.7 LV mass was derived
from the formula described by Devereux and associates8 : LV
Mass
(grams)=0.80x1.04[(VSTd+LVIDd+PWTd)3-(LVIDd)3]+0.6,
where thickness and dimension measurements are expressed in
centimeters.
M-mode echocardiograms of adequate quality for performing M-mode measurements of the left ventricle were available in 1357 men and 2053 women in the entire cohort. As previously described, the entire set of M-mode LV measurements could not be made in 34% of the elderly CHS cohort, with age being the strongest correlate of missing data.3
Other Independent Variables
Eligible participants giving informed consent answered standard
questionnaires on personal habits, transient symptoms (such as syncope,
vertigo, palpitations), family history, and medical history, including
recent hospitalizations and prior cardiac diagnoses and
procedures.9 A comprehensive examination included blood
tests, spirometry, carotid ultrasound, and ECG. Factors considered in
the current report as possible explanatory variables for LV mass
and its components are listed in Table 1
. History of
hypertension and valvular disease were defined by self-report.
Diabetes was defined as fasting glucose greater than or equal to 140
mg/dL (1.4 g/L), 2-hour postglucose load greater than or equal to 200
mg/dL (2.0 g/L), a reported history of diabetes, or use of insulin or
oral hypoglycemic medication. History of MI or CHF were defined as a
reported history of the condition confirmed by medical records or
examination.9 CHD was defined as (1) reported history of
MI, angina pectoris, previous coronary artery bypass surgery,
or coronary angioplasty or (2) silent MI discovered during the
examination.9
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Major and minor ECG abnormalities were defined by the Minnesota code.10 Major ECG abnormalities included one or more of the following: ventricular conduction defect, major Q wave abnormalities, LV hypertrophy, ST-T wave abnormalities, atrial fibrillation, or first-degree atrioventricular block. Minor ECG abnormalities were defined as the presence of one or more of the following: minor Q or QS wave abnormalities, tall R waves, minor isolated ST-T wave abnormalities, ST elevation, incomplete right bundle-branch block, long QT or short PR interval, or right axis deviation.
Statistical Methods
Descriptive statistics and multiple linear regression
analyses were performed with the SPSS statistical package (SPSS
for Windows, version 6.1, SPSS Inc). Bivariate correlations were
calculated between each of the echo measures and each of the continuous
predictors described below under multiple regression analyses.
For the dichotomous predictors, means of each echo variable by
level of predictor were calculated for descriptive purposes.
Multiple regression models for LV mass, ventricular-septal thickness in diastole, LV posterior wall thickness in diastole, and LV dimension in diastole were generated in two ways: by taking the natural logarithms of all continuous variables, and by using variables in their original units. The results from the two methods were similar. For ease of interpretation, only results of the models using variables in their original units are reported.
Table 1
lists the variables available for entry into the multiple
linear regression models. Significant variables were identified by
a stepwise procedure with an entry criterion of P<.01.
Because any case missing a value for any one of the potential
covariates listed in the table was deleted from the model, once the
significant variables were identified, they alone were entered into
a regression model in order to capture the largest number of cases
possible. Of the 3401 participants with LV mass measurements, 2861 (or
84%) had data for all potential covariates listed in Table 1. In
models for which sex was a significant predictor, sex interactions with
other variables in the model were tested for significance.
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Results |
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Relationship of Disease Status and Other Independent Variables to Echo LV Mass and its Components: Descriptive Data
Tables 2
and 3 provide descriptive
data relating various disease states and other independent
variables to LV mass and its component variables in men and
women. In general, echo LV mass, ventricular septal
thickness, and LV posterior wall thickness measurements, unadjusted for
variables such as age, BP, and body size, were greater in men than
women and in those with than those without a history of hypertension,
diabetes, MI, CHF, CHD, or valvular heart disease. In addition,
participants demonstrating major and minor ECG abnormalities or using
antihypertensive medications had higher unadjusted measurements for LV
mass, ventricular septal thickness, LV posterior wall
thickness, and LV diastolic dimension than those without
these conditions. In general, the differences for LV
diastolic dimension were lesser in magnitude than those for
the other three echo LV measurements. However, there were larger
differences in participants with than those without a history of MI or
CHF.
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Bivariate Analyses of Independent Variables Versus Echo
LV Mass and Components
Table 4 lists independent variables that either
demonstrated significant bivariate correlations with LV mass or its
components or appeared in the final regression models. The continuous
variables most strongly correlated with LV mass and its component
variables were the descriptors of body size. LV mass was most
strongly correlated with weight (directly: r=.44) and
bioresistance (inversely: r=-.44) (both
P<.001). Significant correlations with body size
variables, including height, waist and hip circumference, and body
mass index, were also present for the echo components of LV mass,
especially for LV diastolic dimension.
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Multiple Linear Regression Analyses for Predicting LV Mass
and Its Components
Table 5 presents the multiple linear regression
analyses for predicting LV mass and its component variables
in the entire cohort. The linear model explained 37% of the variance
in LV mass.
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Although in addition to height, both waist and hip circumferences, as well as body mass index, were related to LV mass bivariately, these body size variables added nothing once weight was entered in the multiple linear regression models. However, bioresistance remained inversely related to LV mass, as was HDL cholesterol. Furthermore, diastolic BP was inversely and systolic BP positively related to LV mass, with similar magnitudes for their coefficients, consistent with the finding (noted on bivariate analyses) that pulse pressure was a positive predictor of LV mass. Not surprisingly, ECG abnormalities, CHF, valvular heart disease, color Doppler aortic and mitral regurgitation, and use of antihypertensive medications were all associated directly with LV mass. Present smoking was also (weakly) directly associated with LV mass.
In the model for LV mass, there were two significant sex interaction terms: major ECG abnormalities and mitral regurgitation. Since sex was coded "1" for male and "0" for female, females were described by the main effects alone and males were described by both the main effect and the interaction term. Major ECG abnormalities were a significant correlate of LV mass in both men and women: In women, it was associated with an 11.76-g increment in LV mass (all other factors held constant) and in men with an increment of 11.76+13.64=25.40 g. Mitral regurgitation was a significant correlate of LV mass only in men.
The linear model for predicting LV diastolic dimension in the overall cohort explained 27% of the variance. Height entered the model for LV diastolic dimension but not for LV mass or septal or posterior wall thicknesses. Furthermore, age was inversely related to LV diastolic dimension but unrelated to LV mass in multivariate models. Other variables related positively to LV diastolic dimension included body weight, systolic BP, ECG abnormalities, confirmed MI or CHF, and color Doppler aortic regurgitation ratio or mitral regurgitation ratio (in men). Diastolic BP and bioresistance were inversely related to LV diastolic dimension.
The overall multiple linear regression analyses explained less of the variance for ventricular septal thickness (13%) and LV posterior wall thickness (14%) than for LV mass and LV diastolic dimension. For both ventricular septal thickness and LV posterior wall thickness, the models did not differ by sex (and sex interaction terms were nonsignificant). Ventricular septal thickness was positively associated with body weight, systolic BP, history of hypertension, age, major and minor ECG abnormalities, present smoking, and color Doppler aortic regurgitation ratio and inversely related to bioresistance and HDL cholesterol. LV posterior wall thickness was positively associated with body weight, male sex, age, systolic BP, hypertensive medication use, serum albumin, major and minor ECG abnormalities, vasodilator use, and color Doppler aortic regurgitation ratio.
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Discussion |
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The results of our study reveal that LV mass and its component measurements, as derived from two-dimensionally directed M-mode echo, are related to variables in the following categories: (1) body size and obesity, (2) age, (3) sex, (4) BP, history of hypertension, and treatment for hypertension, (5) valvular heart disease by history or by color Doppler echo, (6) CHF, MI, or ECG abnormalities (major and minor), (7) history of smoking, (8) HDL cholesterol, and (9) hematocrit and clotting factors, serum albumin, and uric acid.
Body Size and Obesity
In bivariate analyses, as well as in multiple linear
regression analyses, body weight was generally the strongest
correlate of LV mass. In bivariate models, height, waist and hip
circumferences, body mass index, and bioresistance (a measure of
adiposity) were all related to LV mass and to most of its component
variables. However, after weight was entered into multiple linear
regression analyses for LV mass and each of its component
variables, height, waist and hip circumferences, and body mass
index no longer entered into the models (except for height in the model
for LV diastolic dimension). For each 5-kg increase in body
weight, with other factors constant, LV mass increased, on average, by
1.0 g in the CHS cohort (partial ß=0.21). In contrast,
bioresistance entered models (inverse relationship) for LV mass,
ventricular septal thickness, and LV dimension. The
relationship between total body weight, lean body mass, and body fat
(or adiposity) can be expressed by the following conceptual
equation: Total Body Weight=Lean Body Mass+Body Fat (or Adiposity),
where total body weight is measured directly; waist and hip
circumferences, or bioresistance, are surrogate measures for body fat;
and height is an imperfect measure of lean body mass. This formula
explains why, in multiple linear regression analyses when
weight is allowed to enter the model, measures such as height, waist
and hip circumferences, and body mass index become less significant or
nonsignificant explanatory variables: their explanatory power is
partially or completely subsumed by the total body weight variable.
Furthermore, our models are consistent with the concept that
the combination of total body weight (directly related to LV mass and
its components) and bioresistance (inversely related to LV mass and two
of its components) may actually be measuring lean body mass and
reflecting its importance as a determinant of LV mass.
Our models are consistent with previous reports emphasizing the strong relationship of LV mass to measures of body size (eg, weight and height), lean body mass, and obesity.11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 In CARDIA, a multicenter study sponsored by the National Heart, Lung, and Blood Institute, in multiple linear regression analyses for LV mass in which weight was entered, height was no longer a significant explanatory variable.13 Daniels et al,29 using dual-energy x-ray absorptiometry to determine lean body mass, recently reported in 201 children and adolescents that lean body mass is a more important determinant of LV mass than are either obesity (fat mass) or systolic BP. Furthermore, even in a hypertensive population with a high prevalence of LV hypertrophy, Gottdiener et al27 have reported that body weight is a more important determinant of LV mass than is BP.
Age
In multiple linear regression analyses, when other
variables were allowed to enter the model, age was no longer a
significant explanatory variable for LV mass. The absence of an
association of age and LV mass may be due to the highly truncated age
range; ie, all CHS subjects were at least 65 years old. In contrast,
age was a significant, but relatively minor, explanatory variable
for both ventricular septal thickness and LV posterior wall
thickness (positive relationship) and for LV dimension (inverse
relationship). We have previously shown that among CHS participants,
weight-adjusted LV mass increases modestly (<1 g per year,
P<.0001) with increasing age.3
Ventricular septal thickness and LV posterior wall
thickness have been previously shown in smaller studies to increase
with age.14 15 In these same studies, LV
diastolic dimension decreased slightly with age over a wide
adult age range. Not surprisingly, a positive relationship of age and
LV relative wall thickness has been previously reported by a number of
investigators.22 31 32 33
Sex Differences in Multivariate Associations
Multivariate analyses revealed
significantly higher LV mass (by a mean of 10.6 g) and LV
posterior wall thickness (by a mean of 0.3 mm) in men than women,
even after adjustment for body size variables. In the model for LV
mass, there were two sex interaction terms: major ECG abnormalities and
mitral regurgitation. Major ECG abnormalities were
significantly associated with LV mass in both men and women, whereas
mitral regurgitation was significantly associated only
in men.
The explanation for these sex-specific differences in association with LV mass and its components is not definitively provided by the current study. Possible explanations for sex differences in associations include actual biological differences in echo LV mass or LV posterior wall thickness measurements, or survival bias among women. Consistent with the explanation that a true sex-related biological difference may be present in the elderly CHS cohort, various workers have recently reported that heart size and the ratio of LV mass to height are larger in boys than girls34 and that LV mass is greater in younger adult men versus women.13 35 One might also observe sex-related differences if measurements detecting similar phenomena, and having similar relationships to LV mass variables, differed in prevalence or measurement accuracy by sex, thus affecting statistical power. Finally, apparent sex differences for some variables could be due to chance (when their true contribution is zero) because of the multiple testing involved in deriving the best models for LV mass and its component variables. Longitudinal follow-up of the CHS cohort and sex-specific analyses in other cohorts may help to shed further light on the etiologies for these sex-associated differences in LV mass and its components.
BP, History of Hypertension, and Treatment for
Hypertension
Multiple linear regression analyses for LV mass (and LV
dimension) revealed direct relationships between systolic BP
and LV mass (and internal dimension) and inverse relationships,
approximately equal in magnitude, between diastolic BP and
LV mass (and internal dimension). For diastolic BP, this
represents a reversal of the direction of correlation with LV
mass (which was weakly positive) in bivariate analyses. For
each 10–mm Hg increment in systolic BP, with all other
factors kept constant, LV mass was greater, on average, by 3.0 g
in the CHS cohort. These findings were also present in multiple
linear regression analyses in a healthy subset of the CHS
cohort (data not shown). In consonance with these findings, LV mass and
ventricular septal and posterior wall thicknesses were all
significantly (P<.001) related to pulse pressure in
bivariate models. Since stroke volume is approximated by the formula
(LV Diastolic Dimension)3-(LV Systolic
Dimension)3, it is inherently highly positively correlated
with LV diastolic dimension. In addition, stroke volume was
highly positively related to LV mass in our study (P<.0001,
unadjusted for other variables). Ventricular septal
thickness and LV posterior wall thickness were directly related to
systolic BP but unrelated to diastolic BP in
multiple linear regression analyses.
One possible explanation of the direct relation of pulse pressure but
not diastolic BP to LV mass and its components is that in
older individuals (eg, 
65 years), increasing systemic
arterial stiffness may result primarily in increases in
systolic BP as well as in LV mass and its component septal and
wall thicknesses.36 At a given vascular resistance, if the
rigidity of the aorta and other large arteries is augmented, the
increase in systolic BP should be quantitatively greater than
the decrease in diastolic BP. Stiffening of the
arterial walls and alterations of their mechanical
properties result in a mismatch between aortic impedance and LV
ejection, with other consequences such as increases in LV
mass.37 In a small subset of a large French study,
increased pulse pressure was shown to have an adverse effect on
cardiovascular mortality.38 Previous
reports, confirmed by the findings in this large population study, lend
support to recent recommendations regarding BP treatment in the
elderly, which have suggested focusing primarily on systolic BP
(and perhaps pulse pressure) rather than on diastolic
BP.39 In the CARDIA study, systolic BP was more
strongly correlated with LV mass than was diastolic
BP.13 Similarly, in a Framingham substudy of 152 men and
299 women (mean age, 68±6 years), 30-year average systolic BP
demonstrated significant bivariate correlations with LV mass (corrected
for height) (r=.27 in men and r=.31 in women).
Not only were both current and long-term values for systolic BP
better predictors of LV mass and wall thickness than were current and
long-term values for diastolic BP, but 30-year average
systolic BP proved to be a significant independent predictor of
LV mass in multiple linear regression analyses
(P<.01 in men and women).40
In multiple regression analyses, treatment with antihypertensive medications was directly related to LV mass and weakly (positively) to LV posterior wall thickness, whereas vasodilator treatment was weakly related to posterior wall thickness. A history of hypertension was strongly related to ventricular septal thickness. These relationships were expected in view of the well-known relationships between LV mass and its components and a history of hypertension and BP level.41 42
Valvular Heart Disease
In multiple regression analyses, a history of
valvular heart disease and color Doppler aortic regurgitant
jet ratio were positively associated with LV mass, whereas aortic
regurgitant jet ratio was positively associated with the components of
LV mass. In men, mitral regurgitant jet ratio was associated with LV
mass and diastolic dimension. These findings are
consistent with the well-described LV volume-overload states in
mitral and/or aortic regurgitation, which result in
increased LV dimensions and mass. In a Framingham Heart Study echo
examination of 4976 participants (ages 17 to 90 years), multiple linear
regression analyses revealed that in addition to age,
systolic BP, and obesity, the presence of valve disease and MI
were each independently associated with LV hypertrophy in
both men and women.28
Congestive Heart Failure, Myocardial Infarction, and ECG
Abnormalities
CHF was significantly associated with LV mass but not with
its components in multiple linear regression analyses. Not
surprisingly, major and minor ECG abnormalities were associated with LV
mass and its components since these ECG scores include indicators of LV
voltage. However, somewhat surprisingly, MI was associated only with LV
dimension. Since ECG abnormalities entered the models for LV mass and
its components, it may be that these abnormalities explained some of
the variance that would otherwise have been explained by related
clinical conditions, eg, CHF and MI. In previous analyses in
the CHS cohort, weight-adjusted M-mode echo LV mass was higher in
participants with clinical CHD than in the healthy subgroup. However,
the magnitude of this difference in weight-adjusted LV mass related to
disease status was not as great as the difference related to
sex.3 One possible explanation for the lesser magnitude of
this disease effect is the previously reported high prevalence of
subclinical CHD in elderly individuals.43
Lung Function and Smoking History
Forced expiratory volume in 1 second and forced vital capacity
were directly related to LV mass and diastolic dimension in
bivariate analyses—possibly a reflection of the relationship
of chest cavity size to body size measures—but not in
multivariate models. Multivariate
analyses revealed a weak relationship between smoking history
and LV mass and ventricular septal thickness. In the CARDIA
study, Gidding et al44 found a modest relationship between
smoking history and LV mass.
Cholesterol
In multiple linear regression analyses, higher levels of
HDL cholesterol were associated with lower LV mass and
ventricular septal thickness, consistent with these
individuals having a lower prevalence of clinical CHD or lower CHD
risk. However, these relationships appear to be of modest importance.
In the CARDIA cohort of young adults, there was a weak association
between total cholesterol and LV mass in black men
only.13
Hematocrit and Clotting Factors, Serum Albumin, and
Uric Acid
Fibrinogen, factor VII, factor VIII, and hematocrit did not enter
any of the multiple linear regression analyses for LV mass or
its component variables, despite significant bivariate
relationships of hematocrit and factor VII to LV mass and its component
variables. Of interest, deSimone and associates45
reported a relationship between blood viscosity, as indirectly measured
by hematocrit, and LV mass. This relationship did not appear to be an
important one in the elderly CHS cohort. Serum albumin proved
to be an explanatory variable of modest importance in the multiple
linear regression model for LV posterior wall thickness. Serum
albumin was modestly related to LV posterior wall thickness in
multivariate models, whereas uric acid was related to
LV mass and its components only in bivariate analyses. The
correlations between uric acid and LV echo measurements were reduced by
adjusting for sex, age, height, and weight, but they do not disappear
(for LV mass: r=.06, P<.001).
Strengths and Weaknesses
Strengths of the current study include the large numbers of
men and women studied as well as the well-defined and
consistently measured explanatory variables. Weaknesses of
the present study include the fact that in this elderly cohort,
M-mode echo data were missing in 34% of the participants in the entire
cohort, with the percent missing data increasing with increasing age
from 29% in the 65-to-69 year age group to 50% in the 85+ year age
group (P<.001).3 Another inherent limitation
relates to the cross-sectional design of this analysis, so that
only associations, rather than predictions, can be derived from the
multiple linear regression analyses. Clearly, follow-up
longitudinal studies are necessary to delineate the potential
predictive value of demographic, risk factor, and other variables
studied in the current report for echo changes in LV mass and component
variables.
Although it is known that M-mode may have limitations compared with two-dimensional echo measurements of the left ventricle in individuals with CHD and CHF due to segmental wall motion differences, Devereux et al8 have previously shown a good correlation between M-mode echo and necropsy LV mass measurements, even in individuals with CHD. Two-dimensional echo measurements have their own limitations, eg, LV endocardial dropout in apical views46 In a pilot study in CHS, two-dimensional echo resulted in poorer measurement yield and higher reader variability for LV measurements than did two-dimensionally directed M-mode echo (data not shown). Therefore, in CHS, as in Framingham, echo measurements of LV mass, dimension, and wall thickness were carried out with the two-dimensionally directed M-mode technique.1 2 6 21 22 23 28
In conclusion, in the CHS multicenter cohort of elderly community-dwelling individuals, demographic, risk factor, and disease status variables such as body weight, male sex, systolic BP, pulse pressure, presence of CHF, present smoking, major and minor ECG abnormalities, treatment for hypertension, and mitral and aortic valve regurgitation by color Doppler are positively related, whereas diastolic BP, HDL cholesterol, and bioresistance are inversely related, to echo LV mass and to one or more of its components variables. Multiple linear regression models in this elderly cohort explain less of the variance for ventricular septal thickness (R2=.13) and LV posterior wall thickness (R2=.14) than for LV mass (R2=.37) and LV dimension (R2=.27). New cross-sectional findings in the elderly CHS cohort include the presence of pulse pressure as an independent positive correlate and HDL cholesterol as an inverse correlate of LV mass in multiple linear regression models. Longitudinal studies are currently in progress to delineate the potential value of demographic, risk factor, and other variables, and changes in these variables, in predicting changes in LV mass and its component variables as well as the prognostic significance of LV mass in the elderly.
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Selected Abbreviations and Acronyms |
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Acknowledgments |
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This work was supported by contract Nos. N01-HC-85079 to HC-85086 from the National Heart, Lung, and Blood Institute, Bethesda, Md.
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Footnotes |
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Reprint requests to CHS Coordinating Center, University of Washington, JD-30, 1107 NE 4th St, Rm 530, Seattle, WA 98105.
Received September 17, 1996; first decision October 7, 1996; accepted November 5, 1996.
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References |
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TopAbstractIntroductionMethodsResultsDiscussionReferences |
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Sahn DJ, DeMaria A, Kisslo J, Weyman A. The
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