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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

View larger version (45K): [in a new window]   Figure 1 Strain in different territories (left anterior descending artery [LAD], left circumflex [LCX], and right coronary artery [RCA] territories) according to categories of diastolic blood pressure (A) and systolic blood pressure (B). Relationships between strain and blood pressures presented in this figure are unadjusted. Testing for trend (analysis of variance) indicates presence of significant relationship between diastolic blood pressure and strains (p values indicate significance for such a trend). No such relationship exists between systolic blood pressure and regional left ventricular (LV) function. Mean + standard error (SE) are presented.

View larger version (34K): [in a new window]   Figure 2 (A) Relationship between regional left ventricular (LV) function and smoking status. The relationship between strain and smoking status presented here is unadjusted. White bars = non-smokers; ruled bars = former smokers; black bars indicate current smokers. There is a reduction (absolute) of circumferential strain (Ecc) in left anterior descending (LAD) and right coronary (RCA) in current smokers, as compared with former and non-smokers. Mean + SE are shown. (B) Relationship between cigarette consumption (pack-years) and regional LV function. The relationship between strain and pack-years presented here is unadjusted. White bars = non-smokers (0 pack-years); ruled bars, gray bars, and black bars = 1 to 19, 20 to 39, 40 and more pack-years, respectively. Testing for trend is significant for the LAD and RCA territories. Mean + standard error (SE) are shown.

View larger version (28K): [in a new window]   Figure 3 Combined effect of diastolic blood pressure and smoking status on circumferential strain (Ecc) in left anterior descending (LAD) region. The relationships between strain, diastolic blood pressure (DBP), and smoking shown here reflect unadjusted values. Note that the effect of reduced Ecc in the presence of increased DBP is more pronounced in heavy smoking (20 pack-years). Mean + standard error (SE) are shown.