TY - JOUR
T1 - Association of low-grade albuminuria with adverse cardiac mechanics
T2 - Findings from the hypertension genetic epidemiology network (hypergen) study
AU - Katz, Daniel H.
AU - Selvaraj, Senthil
AU - Aguilar, Frank G.
AU - Martinez, Eva E.
AU - Beussink, Lauren
AU - Kim, Kwang Youn A.
AU - Peng, Jie
AU - Sha, Jin
AU - Irvin, Marguerite R.
AU - Eckfeldt, John H.
AU - Turner, Stephen T.
AU - Freedman, Barry I.
AU - Arnett, Donna K.
AU - Shah, Sanjiv J.
PY - 2014
Y1 - 2014
N2 - BACKGROUND-: Albuminuria is a marker of endothelial dysfunction and has been associated with adverse cardiovascular outcomes. The reasons for this association are unclear but may be attributable to the relationship between endothelial dysfunction and intrinsic myocardial dysfunction. METHODS AND RESULTS-: In the Hypertension Genetic Epidemiology Network (HyperGEN) Study, a population-and family-based study of hypertension, we examined the relationship between urine albumin-to-creatinine ratio (UACR) and cardiac mechanics (n=1894, all of whom had normal left ventricular ejection fraction and wall motion). We performed speckle-tracking echocardiographic analysis to quantify global longitudinal, circumferential, and radial strain, and early diastolic (e′) tissue velocities. We used E/e′ ratio as a marker of increased left ventricular filling pressures. We used multivariable-adjusted linear mixed effect models to determine independent associations between UACR and cardiac mechanics. The mean age was 50±14 years, 59% were female, and 46% were black. Comorbidities were increasingly prevalent among higher UACR quartiles. Albuminuria was associated with global longitudinal strain, global circumferential strain, global radial strain, e′ velocity, and E/e′ ratio on unadjusted analyses. After adjustment for covariates, UACR was independently associated with lower absolute global longitudinal strain (multivariable-adjusted mean global longitudinal strain [95% confidence interval] for UACR Quartile 1 = 15.3 [15.0-15.5]% versus UACR Q4 = 14.6 [14.3-14.9]%, P for trend <0.001) and increased E/e′ ratio (Q1 = 25.3 [23.5-27.1] versus Q4 = 29.0 [27.0-31.0], P=0.003). The association between UACR and global longitudinal strain was present even in participants with UACR < 30 mg/g (P<0.001 after multivariable adjustment). CONCLUSIONS-: Albuminuria, even at low levels, is associated with adverse cardiac mechanics and higher E/e′ ratio.
AB - BACKGROUND-: Albuminuria is a marker of endothelial dysfunction and has been associated with adverse cardiovascular outcomes. The reasons for this association are unclear but may be attributable to the relationship between endothelial dysfunction and intrinsic myocardial dysfunction. METHODS AND RESULTS-: In the Hypertension Genetic Epidemiology Network (HyperGEN) Study, a population-and family-based study of hypertension, we examined the relationship between urine albumin-to-creatinine ratio (UACR) and cardiac mechanics (n=1894, all of whom had normal left ventricular ejection fraction and wall motion). We performed speckle-tracking echocardiographic analysis to quantify global longitudinal, circumferential, and radial strain, and early diastolic (e′) tissue velocities. We used E/e′ ratio as a marker of increased left ventricular filling pressures. We used multivariable-adjusted linear mixed effect models to determine independent associations between UACR and cardiac mechanics. The mean age was 50±14 years, 59% were female, and 46% were black. Comorbidities were increasingly prevalent among higher UACR quartiles. Albuminuria was associated with global longitudinal strain, global circumferential strain, global radial strain, e′ velocity, and E/e′ ratio on unadjusted analyses. After adjustment for covariates, UACR was independently associated with lower absolute global longitudinal strain (multivariable-adjusted mean global longitudinal strain [95% confidence interval] for UACR Quartile 1 = 15.3 [15.0-15.5]% versus UACR Q4 = 14.6 [14.3-14.9]%, P for trend <0.001) and increased E/e′ ratio (Q1 = 25.3 [23.5-27.1] versus Q4 = 29.0 [27.0-31.0], P=0.003). The association between UACR and global longitudinal strain was present even in participants with UACR < 30 mg/g (P<0.001 after multivariable adjustment). CONCLUSIONS-: Albuminuria, even at low levels, is associated with adverse cardiac mechanics and higher E/e′ ratio.
KW - albuminuria
KW - echocardiography
KW - ventricular function
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U2 - 10.1161/CIRCULATIONAHA.113.003429
DO - 10.1161/CIRCULATIONAHA.113.003429
M3 - Article
C2 - 24077169
AN - SCOPUS:84891870363
SN - 0009-7322
VL - 129
SP - 42
EP - 50
JO - Circulation
JF - Circulation
IS - 1
ER -