International Centre for Circulatory Health, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, and Imperial College Healthcare National Health Service Trust, London, UK.
Hypertension. 2013 May;61(5):1014-20. doi: 10.1161/HYPERTENSIONAHA.111.00610. Epub 2013 Mar 11.
Cardiometabolic risk is elevated in South Asians and African Caribbeans compared with Europeans, yet whether this is associated with ethnic differences in left-ventricular structure is unclear. Conventional M-mode or 2-dimensional echocardiography may be misleading, because they calculate left-ventricular mass and remodeling using geometric assumptions. Left-ventricular structure was compared in a triethnic population-based cohort using conventional and 3-dimensional echocardiography on 895 individuals (aged 55-85 years; 427 European, 325 South Asian, 143 African Caribbean). Left-ventricular mass was indexed, and left-ventricle remodeling index and relative wall thickness were calculated. Anthropometry, blood pressure, and fasting bloods were measured. Three-dimensional left-ventricular mass index did not differ between Europeans (mean ± SE, 29.8 ± 0.3 g/m(2.7)) and African Caribbeans (29.9 ± 0.5 g/m(2.7); P=0.9), but it was significantly lower in South Asians (28.1 ± 0.4 g/m(2.7); P<0.0001) compared with Europeans. These findings persisted on multivariate adjustment. In contrast, conventional left-ventricle mass index was significantly higher in African Caribbeans (46.4 ± 0.9 g/m(2.7)) than in Europeans (41.9 ± 0.5 g/m(2.7); P<0.0001). Left-ventricle remodeling index was the highest in African Caribbeans and the lowest in South Asians. Relative wall thickness was also higher in African Caribbeans, but no different in South Asians, compared with Europeans. Differences in left-ventricle remodeling index were attenuated by adjustment for cardiometabolic factors between African Caribbeans and Europeans only. In conclusion, left-ventricular mass is lower in South Asians and equivalent in African Caribbeans compared with Europeans, even when cardiometabolic risk factors are accounted for. Left-ventricular remodeling rather than hypertrophy may explain the increased risk of heart failure in people of African Caribbean origin.
与欧洲人相比，南亚人和加勒比非洲人患心脏代谢风险更高，但这是否与左心室结构的种族差异有关尚不清楚。传统的 M 模式或二维超声心动图可能会产生误导，因为它们使用几何假设来计算左心室质量和重构。在一个基于三民族的队列中，使用传统和三维超声心动图比较了 895 名（年龄 55-85 岁；427 名欧洲人，325 名南亚人，143 名加勒比非洲人）个体的左心室结构。对左心室质量进行了指数化，并计算了左心室重构指数和相对壁厚度。测量了人体测量学、血压和空腹血样。欧洲人的三维左心室质量指数没有差异（平均值 ± SE，29.8 ± 0.3 g/m2.7）和加勒比非洲人（29.9 ± 0.5 g/m2.7；P=0.9），但南亚人明显较低（28.1 ± 0.4 g/m2.7；P<0.0001）与欧洲人相比。这些发现经多元调整后仍然存在。相比之下，非洲加勒比人的传统左心室质量指数（46.4 ± 0.9 g/m2.7）明显高于欧洲人（41.9 ± 0.5 g/m2.7；P<0.0001）。左心室重构指数在加勒比非洲人中最高，在南亚人中最低。相对壁厚度在加勒比非洲人中也较高，但与欧洲人相比，南亚人中没有差异。只有在调整了非洲加勒比人和欧洲人之间的心脏代谢因素后，左心室重构指数的差异才会减弱。总之，即使考虑到心脏代谢危险因素，南亚人的左心室质量也低于欧洲人，而与欧洲人相当。左心室重构而不是肥大可能解释了非洲加勒比裔人群心力衰竭风险增加的原因。
