Department of Medicine, Columbia University, New York, New York.
Department of Biostatistics, Columbia University, New York, New York.
J Am Soc Echocardiogr. 2019 Oct;32(10):1318-1325. doi: 10.1016/j.echo.2019.05.018. Epub 2019 Jul 13.
Left ventricular (LV) hypertrophy is an independent risk factor for cardiovascular outcomes. There are limited data about modifiable factors associated with progression of LV hypertrophy in older adults. Our objective is to describe the changes in LV mass and geometry over time in a predominantly older multiethnic cohort and to identify possible predictors of changes over time.
We analyzed data from participants in the Northern Manhattan Study who underwent serial echocardiographic studies, comparing the baseline and the most recent echocardiograms. We recorded changes in LV mass and geometry and correlated them with baseline characteristics using linear regression models.
There were 826 participants (mean age, 64.2 ± 8.0 years) included in the analysis (time between measurements, 8.5 ± 2.7 years). Overall, LV mass index increased from 45.0 ± 12.7 to 50.3 ± 14.6 g/m (P < .001). There were 548 participants (66.3%) with LV mass increase; 258 individuals (31.2%) showed worsening LV geometry. Multivariable analysis showed that change in LV mass index was independently associated with baseline LV mass index (β estimate, -17.000 [standard error, 1.508]; P < .001), hypertension (2.094 [0.816], P = .011), body mass index (0.503 [0.088], P < .001), and waist-to-hip ratio (1.031 [0.385], P = .008). Both waist-to-hip ratio and waist-to-height ratio remained significantly associated with LV mass increase even after adjusting for body mass index (P = .008 and P = .036, respectively).
Regardless of race/ethnicity, LV mass progressed over time in older adults. We also observed that worsening geometry was frequent. Assessment of central obesity in the older population is important because indicators of central obesity add prognostic value over body mass index for the risk of LV mass increase.
左心室（LV）肥大是心血管结局的独立危险因素。关于与老年人 LV 肥大进展相关的可改变因素的数据有限。我们的目的是描述在以老年人为主的多民族队列中 LV 质量和几何结构随时间的变化，并确定随时间变化的可能预测因素。
我们分析了参加北方曼哈顿研究的参与者的连续超声心动图研究的数据，比较了基线和最近的超声心动图。我们记录了 LV 质量和几何结构的变化，并使用线性回归模型将其与基线特征相关联。
共有 826 名参与者（平均年龄 64.2±8.0 岁）纳入分析（两次测量之间的时间间隔为 8.5±2.7 年）。总体而言，LV 质量指数从 45.0±12.7 增加到 50.3±14.6 g/m（P<.001）。有 548 名参与者（66.3%）的 LV 质量增加；258 人（31.2%）的 LV 几何结构恶化。多变量分析显示，LV 质量指数的变化与基线 LV 质量指数独立相关（β估计值，-17.000 [标准误差，1.508]；P<.001）、高血压（2.094 [0.816]，P=.011）、体重指数（0.503 [0.088]，P<.001）和腰围臀围比（1.031 [0.385]，P=.008）。即使在调整体重指数后，腰围臀围比和腰围身高比仍与 LV 质量增加显著相关（P=.008 和 P=.036）。
无论种族/民族如何，老年人的 LV 质量随时间推移而进展。我们还观察到，几何结构恶化很常见。在老年人群中评估中心性肥胖很重要，因为中心性肥胖指标比体重指数对 LV 质量增加的风险具有更大的预后价值。
