Abstract 14497: Concentric Remodeling is Associated with Impaired Longitudinal and Radial Deformation Despite Higher LVEF: An Analysis of 893 Elderly Participants in the Atherosclerosis Risk in Communities (ARIC) Study

Abstract

Background: Although concentric remodeling is associated with impaired diastolic function, its relationship to systolic function has not been well defined. We hypothesize that concentric remodeling is associated with abnormalities in left ventricular (LV) systolic function not reflected in ejection fraction (EF).

Methods: Conventional and speckle tracking-based myocardial deformation analyses were performed at a core laboratory in 893 elderly participants in the Atherosclerosis Risk in Communities (ARIC) study, who were free of significant valvular disease. Concentric remodeling, quantified as relative wall thickness (RWT), was studied in relation to LV wall stress, chamber-level systolic measures (LVEF), ejection-phase measures (stroke volume index [SVI]), and longitudinal, circumferential, and radial strain.

Results: Mean age was 75±5 years, 57% were women, 88% white, 60% had a history of hypertension, 25% diabetes, and 6% heart failure. Mean RWT was 0.42±0.08 (range 0.21 - 0.88). Higher RWT was associated with older age (correlation r = 0.15, p<0.0001), non-white race (p<0.0001), and history of hypertension (p<0.0001) and diabetes (p=0.005). Higher RWT was significantly associated with smaller LV volume (r = -0.20, p<0.0001), greater wall thickness (r = 0.61, p<0.0001), lower meridional (r = -0.52, p<0.0001) and circumferential (r = -0.50, p<0.0001) wall stress, and higher chamber-level measures of pump function (LVEF; Table). Despite higher LVEF and lower wall stress, greater RWT was associated with lower SVI, mid-wall fractional shortening, and longitudinal and radial deformation.

Conclusions: Concentric remodeling is associated with reduced myocardial longitudinal and radial deformation despite higher LVEF. Further studies are needed to determine the clinical and prognostic relevance of these impairments in systolic function, particularly for heart failure with preserved LVEF.