Hispanics are under-represented in heart failure (HF) clinical trials and epidemiologic studies. The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) baseline cohort did not include an echo exam. The NIH-funded Echocardiographic Study of Latinos (ECHO-SOL; PI Dr. Rodriguez) was designed to fill this critical gap. We successfully performed echocardiograms including advanced techniques such as tissue Doppler, strain and speckle tracking in a representative subset of the HCHS/SOL baseline cohort. Our preliminary data indicate that despite a relatively young age of 56+0.4 years, the prevalence of left ventricular (LV) hypertrophy, abnormal LV geometry and diastolic dysfunction was higher than previously reported in non- Hispanic whites. In addition, acculturation factors, relevant to Hispanics and understudied in relation to HF risk, significantly impacted on the 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 of cardiac structural and functional abnormalities 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 CARDIA, show that changes in cardiac echo parameters within a 3-5 year period can predict incident HF. Our ECHO-SOL data show the feasibility of assessing cardiac progression with serial echo exams. However, the current HCHS/SOL 2nd exam does not include repeat echo measures on ECHO-SOL participants. Thus, we propose to leverage the unique resources of ECHO-SOL and the HCHS/SOL 2nd exam by repeating a high quality echo (ECHO-SOL 2) in this high risk cohort on average 4-5 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 change in serial echo parameters in relation to the rich database of clinical, sociocultural, socioeconomic and psychosocial risk factors from HCHS/SOL. 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 torsion). ECHO-SOL 2 will facilitate the screening and identification of Hispanics who are at greatest HF risk, who can then be targeted for aggressive risk factor control to lower the burden of HF in this vulnerable population.
This is the first ever study to assess serial change of cardiac structure / function / mechanics and their correlates in a population-based cohort of Hispanics, incorporating novel serial STE-based analyses (LV strain and LV torsion) to complement conventional assessment of LV systolic / diastolic function. The proposed research 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.
| Balfour Jr, Pelbreton C; Ruiz, John M; Talavera, Gregory A et al. (2016) Cardiovascular Disease in Hispanics/Latinos in the United States. J Lat Psychol 4:98-113 |
