Hispanics are under-represented in heart failure (HF) clinical trials and epidemiologic studies. The contract funded Hispanic Community Health Study/Study of Latinos (HCHS/SOL) did not include a provision for a baseline echo exam. The NIH-funded Echocardiographic Study of Latinos (ECHO-SOL; PI Dr. Rodriguez) helped fill this critical gap. We successfully performed echo exams using techniques such as tissue Doppler and speckle tracking in a representative subset of the HCHS/SOL baseline cohort. Our preliminary data show that despite a relatively young age of 56+0.4 years, the prevalence of left ventricular (LV) hypertrophy, abnormal LV geometry and diastolic dysfunction is higher among Hispanics than previously reported in non- Hispanic whites. In addition, acculturation, a factor relevant to Hispanics but understudied in relation to HF risk, was significantly associated with a higher prevalence of cardiac structural and functional abnormalities. In HF, progression from Stage A (HF risk factors alone) to Stage B (abnormalities of cardiac structure and function) to Stage C (clinical symptomatic HF; either with preserved [HFpEF] or reduced EF [HFrEF]) is an incredibly important process. There is a shortage of longitudinal cohort studies on progression across the HF stages in racial/ethnic minorities. Longitudinal data are essential to determine if distinct patterns of change in cardiac phenotypes from stage A to B HF can identify individuals on a trajectory towards developing clinical HF. Cohorts of non-Hispanics, such as the FHS and CHS, show that changes in cardiac echo parameters within a 4-5 year period can predict incident HF. Our ECHO-SOL data show the feasibility of assessing cardiac progression with serial echo exams in our unique cohort. However, the current contract funded HCHS/SOL 2nd exam does not include echo exams on ECHO-SOL participants. Thus, we propose to leverage the unique resources of ECHO-SOL and the HCHS/SOL 2nd exam in order to repeat a high quality echo (ECHO-SOL 2) in the ECHO-SOL cohort on average five years post- baseline. The overall goal is to determine how the transition in traditional HF risk factors impacts longitudinal change of cardiac abnormalities by assessing serial change in echo parameters in relation to the rich clinical, sociocultural, socioeconomic and psychosocial HCHS/SOL database. ECHO-SOL 2 represents an innovative and cost-effective approach to advance our understanding of the links between progression of HF risk factor with progression of abnormal cardiac structure and function. ECHO-SOL 2 will identify patterns of HF risk factor progression and the trajectory of early cardiac dysfunction that can differentiate Hispanic adults as more or less likely to develop HF; utilizing the conjoint contributions of conventional assessment of cardiac structure and systolic / diastolic function with more novel echo measures (LV strain and twist). ECHO-SOL 2 will facilitate the screening and identification of Hispanics who are at greatest HF risk, and can then be targeted for aggressive risk factor control to lower the burden of clinical HF in this vulnerable population.
This is the first ever study to assess serial change of cardiac structure / function / mechanics and the correlates of change in a population-based cohort of Hispanics, incorporating novel serial STE-based analyses (LV strain and LV twist) to complement conventional assessment of LV systolic / diastolic function. The proposed research also represents a novel approach to understanding how progression of HF risk factors (from pre-DM to DM, pre-HTN to HTN or from normal BMI to obesity) relate to changes in cardiac phenotypes and potentially to clinical HF. Investigation into this very important area will be extremely promising in learning about Hispanic cardiovascular health and highly relevant to future public health planning.
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