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CLINICAL RESEARCH: LV FUNCTION AND RISK

Hypertension and Smoking Are Associated With Reduced Regional Left Ventricular Function in Asymptomatic Individuals

The Multi-Ethnic Study of Atherosclerosis

Boaz D. Rosen, MD^_*, Mohammed F. Saad, MD, Steven Shea, MD, MSC, Khurram Nasir, MD^_*, Thor Edvardsen, MD, PhD^_*, Gregory Burke, MD, PhD^||, Michael Jerosch-Herold, PhD^¶, Donna K. Arnett, PhD^¶, Shenghan Lai, MD, PhD^#, David A. Bluemke, MD, PhD and João A.C. Lima, MD^_*,,_*

^_* Division of Cardiology, Johns Hopkins Medical Institutions, Baltimore, Maryland
Radiology Department, Johns Hopkins Medical Institutions, Baltimore, Maryland
Los Angeles Diabetes Center, UCLA, Los Angeles, California
Departments of Medicine and Epidemiology, Columbia University, New York, New York
^|| Wake-Forest University School of Medicine, Winston-Salem, North Carolina
^¶ University of Minnesota, Minneapolis, Minnesota
^# Department of Epidemiology, Bloomberg School of Public Health and Hygiene, Johns Hopkins University, Baltimore, Maryland

Manuscript received April 15, 2005; revised manuscript received July 14, 2005, accepted August 12, 2005.

^_* Reprint requests and correspondence: Dr. João A. C. Lima, Cardiology Division, Blalock, 524, Johns Hopkins Hospital, 600 N. Wolfe Street, Baltimore, Maryland 21287-0409. (Email: jlima{at}jhmi.edu).

OBJECTIVES: This study sought to test the hypothesis that reduced regional left ventricular (LV) function is associated with traditional risk factors including hypertension, hypercholesterolemia, and smoking in asymptomatic individuals.

BACKGROUND: Coronary artery disease is the main etiology of congestive heart failure in the U.S. and Europe. However, the relationship between risk factors for coronary artery disease and decreased myocardial function has not been studied systematically in asymptomatic individuals.

METHODS: The Multi-Ethnic Study of Atherosclerosis (MESA) is a cohort study designed to investigate the nature of atherosclerosis in asymptomatic individuals. A total of 1,184 participants (45 to 84 years old) underwent tagged cardiac magnetic resonance imaging. Regional LV function was quantified by analyzing peak systolic circumferential strain (Ecc) in regions corresponding to the left anterior descending (LAD), circumflex (LCX), and right coronary (RCA) territories. The association between risk factors and strains was studied using multiple linear regression.

RESULTS: Higher diastolic blood pressure (DBP) was associated with lower Ecc (p 0.002). The Ecc’s in the LAD territory of participants with DBP <80, 80 to 84, 85 to 89, and 90 mm Hg were –15.6%, –14.8%, –14.2%, and –13.7%, respectively (p < 0.001). Similar results were documented in other territories and after multivariable analysis. Smokers had lower Ecc in the LAD and RCA regions compared with nonsmokers. Furthermore, dose response relationship between cigarette consumption measured in pack-years and regional LV dysfunction by Ecc was noted (p 0.01 in LAD and RCA territories). Finally, combined diastolic hypertension and smoking was associated with a greater reduction of regional LV function.

CONCLUSIONS: Higher diastolic blood pressure and smoking are associated with decreased regional LV function in asymptomatic individuals.

Abbreviations and Acronyms   DBP = diastolic blood pressure   Ecc = circumferential strain   HDL = high-density lipoprotein   LAD = left anterior descending   LCX = left circumflex   LDL = low-density lipoprotein   LV = left ventricle/ventricular   MESA = Multi-Ethnic Study of Atherosclerosis   MRI = magnetic resonance imaging   RCA = right coronary artery   SBP = systolic blood pressure

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