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(Circulation. 2008;118:2252-2258.)
© 2008 American Heart Association, Inc.

Epidemiology

Relations of Biomarkers Representing Distinct Biological Pathways to Left Ventricular Geometry

Raghava S. Velagaleti, MD; Philimon Gona, PhD; Daniel Levy, MD; Jayashri Aragam, MD; Martin G. Larson, ScD; Geoffrey H. Tofler, MD; Wolfgang Lieb, MD; Thomas J. Wang, MD; Emelia J. Benjamin, MD, ScM; Ramachandran S. Vasan, MD

From the Framingham Heart Study, Framingham, Mass (R.S. Velagaleti, P.G., D.L., M.G.L., W.L., T.J.W., E.J.B., R.S. Vasan); Department of Mathematics and Statistics (P.G., M.G.L.), Center for Population Studies, National Heart, Lung, and Blood Institute (D.L.), Veterans Administration Hospital (J.A.), West Roxbury, Mass; Cardiology Department, Royal North Shore Hospital, Sydney, Australia (G.H.T.); and Division of Cardiology (T.J.W.), Massachusetts General Hospital, and Preventative Medicine and Cardiology Sections (E.J.B., R.S. Vasan), School of Medicine and Epidemiology, Department of School of Public Health, Boston University, Boston, Mass.

Correspondence to Ramachandran S. Vasan, MD, Framingham Heart Study, 73 Mount Wayte Ave, Framingham, MA 01702-5803. E-mail vasan{at}bu.edu

Received August 25, 2008; accepted September 17, 2008.

Background— Several biological pathways are activated concomitantly during left ventricular (LV) remodeling. However, the relative contribution of circulating biomarkers representing these distinct pathways to LV geometry is unclear.

Methods and Results— We evaluated 2119 Framingham Offspring Study participants (mean age, 57 years; 57% women) who underwent measurements of biomarkers of inflammation (C-reactive protein), hemostasis (fibrinogen and plasminogen activator inhibitor-1), neurohormonal activation (B-type natriuretic peptide), and renin-angiotensin-aldosterone system (aldosterone and renin modeled as a ratio [ARR]) and echocardiography at a routine examination. LV geometry was defined on the basis of sex-specific distributions of LV mass (LVM) and relative wall thickness (RWT): normal (LVM and RWT <80th percentile), concentric remodeling (LVM <80th percentile but RWT 80th percentile), eccentric hypertrophy (LVM 80th percentile but RWT <80th percentile), and concentric hypertrophy (LVM and RWT 80th percentile). We related the biomarker panel to LV geometry using polytomous logistic regression adjusting for clinical covariates and used backwards elimination to identify a parsimonious set of biomarkers associated with LV geometry. Modeled individually, C-reactive protein, fibrinogen, plasminogen activator inhibitor-1, and ARR were related to LV geometry (P<0.01). In multivariable analyses, the biomarker panel was significantly related to altered LV geometry (P<0.0001). On backwards elimination, logARR alone was significantly and positively associated with eccentric (odds ratio per SD increment, 1.20; 95% confidence interval, 1.05 to 1.37) and concentric LV hypertrophy (odds ratio per SD increment, 1.29; 95% confidence interval, 1.06 to 1.58).

Conclusions— Our cross-sectional observations on a large community-based sample identified ARR as a key correlate of concentric and eccentric LV hypertrophy, consistent with a major role for the renin-angiotensin-aldosterone system in LV remodeling.

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Clinical Summaries
Circulation 2008 118: 2219-2220. [Extract] [Full Text]