Abstract 8784: Association between Cystatin C and Left Ventricular Structure and Function in the Multi Ethnic Study of Atherosclerosis
Introduction Elevated Cystatin C, a marker of renal insufficiency, is associated with diastolic dysfunction, heart failure, and cardiovascular mortality; however, the precise mechanism(s) that account for these relationships remain unclear. This is a cross-sectional examination of the association between Cystatin C and left ventricular structure and function in a multi-ethnic population free of cardiovascular disease. Hypothesis We assesed the hypothesis that elevated Cystatin C is associated with left ventricular remodeling. Methods The measures of Cystatin C and left ventricular parameters were obtained from the Multi-Ethnic Study of Atherosclerosis at baseline (N=4116 with complete data on Cystatin C and LV parameters). LV parameters included LV end- diastolic and end-systolic volumes, LV end diastolic mass, LV ejection fraction and concentricity (ratio of LV end diastolic mass/LV end- diastolic volume) measured using magnetic resonance imaging. Nested linear models were used to examine the relationship between increasing quartiles of Cystatin C and LV parameters with and without adjustment for age, race, gender, height, weight, and history of diabetes, anti-diabetic medications, hypertension, systolic blood pressure, anti-hypertensive medications, total cholesterol, anti-lipid medications, smoking, C - reactive protein, BNP and cTnT. Results In the fully adjusted model, a linear trend of higher quartiles of Cystatin C with lower LV end-diastolic volumes (129, 128.7, 127 and 124 mL) was observed (P=0.0001). Similar associations were found with lower LV end-systolic volumes (P=0.004) and higher prevalence of concentric remodeling (p=0.0001). In contrast, no association was detected between Cystatin C levels and LV ejection fraction or LV end-diastolic mass. Conclusions Cystatin C levels are inversely associated with left ventricular end diastolic and systolic volumes and directly associated with LV remodeling, independent of blood pressure and antihypertensive medications use in a multi-ethnic population. This morphometric pattern of concentric left ventricular remodeling, may in part explain previously observed associations between Cystatin C and diastolic dysfunction, heart failure and cardiovascular mortality.
- © 2010 by American Heart Association, Inc.