Abstract 17673: How Does the Skin to Right Ventricle Distance Relate to Risk Factors for Coronary Artery Disease, Anthropometric Measurements and Carotid Intima Media Thickness?

Abstract

Objective: To determine the relationship of SkRV to CAD risk factors (RFs), athropometric measurements (AM), and body composition.

Background: The distance between the parasternal chest skin and the right ventricular (RV) epicardium SkRV is readily measureable on echocardiography. If SkRV is increased with body size, it may indicate increased cardiovascular disease (CVD) risk and cardiac injury risk from chest wall penetration (from trauma, surgical procedures, Taser dart). Multiple variables may relate to SkRV but have not been comparatively examined.

Methods: We measured body mass index (BMI), waist (WC) and neck cirumference (NC) and percent body fat (%BF) by bioelectrical impendance (RJL Systems) in 150 patients (age 46.5 ± 10.6 years; 57% female, 68% black) who presented to our clinical decision unit with chest pain and no CVD history. Clinical RFs were recorded. SkRV was measured as the maximal distance from the skin to the RV epicardium in end-systole perpendicular to the long axis of the ascending aorta. Carotid intima media thickness (IMT) was imaged with a 10 MHz linear array transducer (Vivd 7, GE). Data were analyzed using Student’s t-test, analysis of variance and multiple regression.

Results: SkRV measured 28.9 + 6.9 mm (range = 11 to 47) and was independently related to age, race, and anthropometric measurements in all regression models (for BMI model, p<0.0001; BMI b = 0.4, age b = 0.2, race b = 5.4), and gender and current smoking in some models. SkRV was increased with age, white race and increased BMI, WC, NC, and %BF and decreased in current smokers. Other CVD RFs did not show a significant relationship. Gender effect was inconsistent. IMT had a significant dependent relationship (Pearson r = 0.27, p = 0.001 for maximum IMT), but no significant independent relationship. Pearson correlation coefficients (all p<0.0001) for AMs and SkRV were: 0.46 (BMI), 0.55 (WC), 0.37 (NC), 0.4 (%BF).

Conclusion: Anthropometric measurements, age, and white race are associated with increased SkRV. Of CVD RFs, only current smoking and inconsistently gender were related to SkRV. The relationship of IMT to SkRV may be mediated by other CVD risk factors.