Abstract 218: The Relationship Between Left Ventricular Hypertrophy and Temporal Decline in Myocardial Function: Longitudinal Analysis of Myocardial Tagging in the Multi-Ethnic Study of Atherosclerosis (MESA)
Left ventricular hypertrophy (LVH) is a strong independent predictor of incident heart failure, but its pathophysiology is poorly understood. We sought a relationship between LV Mass and temporal decline in strain.
Methods: Average LV peak systolic circumferential strain (LV Ecc) was determined by Harmonic Phase analysis in 802 asymptomatic MESA participants at 2 MRI exams (~4.4 years apart). Participants were stratified into gender specific quartiles of LV end diastolic mass (LVEDM), measured at baseline, separately normalized by BMI and body surface area (BSA). LV Ecc at baseline, follow-up and temporal change (follow-up - baseline) was averaged for each quartile and compared to the first quartile. Multiple linear regression was used to adjust for age, ethnicity, history of hypertension, hypertensive medications, heart rate, smoking, lipids, and C-reactive protein.
Results: In men (n=412), LV Ecc was significantly lower in the highest quartile of normalized LVEDM compared to the lowest quartile. Accounting for all covariates, there was a significant decline in absolute strain from baseline to follow-up in the highest quartile of LVEDM normalized by BMI (0.64% decrease, p = 0.006) and BSA (0.27% decrease, p = 0.04) compared to lowest quartile. In women (n=390), the trend was toward improvement in function across all quartiles of LVEDM, to a lesser degree in the highest quartile of LVEDM by BMI (p = 0.047).
Conclusion: We found a significant trend in men for decreased systolic function with increasing LVEDM in cross sectional and longitudinal analyses of strain. Subclinical impairment and temporal decline in myocardial function may underlie the link between LVH and heart failure.