Association of smoking and right ventricular function in middle age: CARDIA study

Henrique T. Moreira, Anderson C. Armstrong, Chike C. Nwabuo, Henrique D. Vasconcellos, Andre Schmidt, Ravi K. Sharma, Bharath Ambale-Venkatesh, Mohammad R. Ostovaneh, Catarina I. Kiefe, Cora E. Lewis, Pamela J. Schreiner, Stephen Sidney, Kofo O. Ogunyankin, Samuel S. Gidding, Joao A.C. Lima

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Objective: To evaluate the association of cigarette smoking and right ventricular (RV) systolic and diastolic functions in a population-based cohort of individuals at middle age.

Methods: This cross-sectional study included participants who answered the smoking questionnaire and underwent echocardiography at the Coronary Artery Risk Development in Young Adulthood year 25 examination. RV systolic function was assessed by echocardiographic-derived tricuspid annular plane systolic excursion (TAPSE) and by right ventricular peak systolic velocity (RVS'), while RV diastolic function was evaluated by early right ventricular tissue velocity (RVE'). Multivariable linear regression models assessed the relationship of smoking with RV function, adjusting for age, sex, race, body mass index, systolic blood pressure, total cholesterol, high-density lipoprotein (HDL) cholesterol, diabetes mellitus, alcohol consumption, pulmonary function, left ventricular systolic and diastolic function and coronary artery calcium score.

Results: A total of 3424 participants were included. The mean age was 50±4 years; 57% were female; and 53% were black. There were 2106 (61%) never smokers, 750 (22%) former smokers and 589 (17%) current smokers. In the multivariable analysis, current smokers had significantly lower TAPSE (β=-0.082, SE=0.031, p=0.008), RVS' (β=-0.343, SE=0.156, p=0.028) and RVE' (β=-0.715, SE=0.195, p<0.001) compared with never smokers. Former smokers had a significantly lower RVE' compared with never smokers (β=-0.414, SE=0.162, p=0.011), whereas no significant difference in RV systolic function was found between former smokers and never smokers.

Conclusions: In a large multicenter community-based biracial cohort of middle-aged individuals, smoking was independently related to both worse RV systolic and diastolic functions.

Original languageEnglish (US)
Article numbere001270
JournalOpen Heart
Issue number1
StatePublished - Mar 8 2020

Bibliographical note

Funding Information:
Funding The Coronary Artery Risk Development in Young Adults Study is supported by contracts HHSN268201800003I, HHSN268201800004I, HHSN268201800005I, HHSN268201800006I and HHSN268201800007I from the National Heart, Lung, and Blood Institute.

Publisher Copyright:
© © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.


  • cardiac function
  • echocardiography
  • smoking
  • Predictive Value of Tests
  • Smokers
  • Age Factors
  • Cross-Sectional Studies
  • Risk Assessment
  • United States
  • Humans
  • Middle Aged
  • Non-Smokers
  • Risk Factors
  • Male
  • Smoking/adverse effects
  • Ventricular Dysfunction, Right/diagnostic imaging
  • Echocardiography, Doppler
  • Female
  • Ex-Smokers
  • Ventricular Function, Right

PubMed: MeSH publication types

  • Multicenter Study
  • Journal Article
  • Research Support, N.I.H., Extramural
  • Comparative Study


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