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Optimal threshold value for left ventricular hypertrophy in blacks: the Atherosclerosis Risk in Communities study.

TitleOptimal threshold value for left ventricular hypertrophy in blacks: the Atherosclerosis Risk in Communities study.
Publication TypeJournal Article
Year of Publication2005
AuthorsNunez E, Arnett DK, Benjamin EJ, Liebson PR, Skelton TN, Taylor H, Andrew M
JournalHypertension
Volume45
Issue1
Pagination58-63
Date Published2005 Jan
ISSN1524-4563
KeywordsAfrican Americans, Blood Pressure, Cholesterol, Cohort Studies, Coronary Disease, Diabetes Mellitus, Female, Follow-Up Studies, Heart Ventricles, Humans, Hypertension, Hypertrophy, Left Ventricular, Incidence, Lipoproteins, HDL, Male, Middle Aged, Mississippi, Normal Distribution, Organ Size, Proportional Hazards Models, Reference Values, Risk Factors, ROC Curve, Sensitivity and Specificity, Smoking, Socioeconomic Factors, Stroke, Ultrasonography
Abstract

The distribution of echocardiographic left ventricular (LV) mass differs among ethnicities. Because ethnic-specific echocardiographic criteria for LV hypertrophy (LVH) are not established, we determined whether threshold values derived from overwhelmingly white populations are appropriate for blacks, a subgroup having more LVH. Between 1992 and 1994, LV mass was measured echocardiographically in the Jackson, Mississippi, black cohort of the Atherosclerosis Risk in Communities study. Participants free of prevalent cardiovascular disease (CVD) (n=1616; mean+/-SD, age 59+/-5.7; 65% women and 57% with hypertension) were included. The optimal LVH threshold value was selected from the continuum of LV mass index (LVMI=LV mass/height(2.7)) using 3 methods: (1) the best operating point from the area under the resulting receiver-operating characteristic (ROC) curve predicting incident CVD; (2) the value with the smallest probability value associated with incident CVD; and (3) visual inspection of functions of LVMI and CVD in the general additive model (GAM) plot. At a median follow-up of 6.8 years, there were 192 events (coronary heart disease=87, stroke=62, and congestive heart failure=43; incidence=17.6/1000 person-years). The best operating point from the resulting ROC analysis was 51.2 g/m(2.7) for sensitivity (53.4%) and specificity (61.5%). The Cox and GAM models adjusted for age, gender, systolic blood pressure, hypertension, diabetes, smoking, total cholesterol-to-high-density lipoprotein ratio, LVH by ECG criterion, and socioeconomic status found 50 to 51 g/m(2.7) as the optimal threshold for LVH in middle-aged blacks, corresponding to a minimum probability value and to a log-hazard ratio of zero, respectively. Because these values are close to the 51 g/m(2.7) established from predominantly white populations, this cutpoint is appropriate for both groups.

DOI10.1161/01.HYP.0000149951.70491.4c
Alternate JournalHypertension
PubMed ID15569859
Grant ListN01 HC55015 / HC / NHLBI NIH HHS / United States
N01 HC55016 / HC / NHLBI NIH HHS / United States
N01 HC55018 / HC / NHLBI NIH HHS / United States
N01 HC55019 / HC / NHLBI NIH HHS / United States
N01 HC55020 / HC / NHLBI NIH HHS / United States
N01 HC55021 / HC / NHLBI NIH HHS / United States
N01 HC55022 / HC / NHLBI NIH HHS / United States