Search PubMed⌕ Search

Biomedical subjects

M J Roman

Publications and source records attributed to M J Roman.

At least 55 records · Page 3Linked to original sources
PubMed2000

Impact of arterial stiffening on left ventricular structure.

Aging of the vasculature results in arterial stiffening and an increase in systolic and pulse pressures. Although pressure load is a stimulus for left ventricular hypertrophy, the extent to which vascular stiffening per se, independent of blood pressure, influences left ventricular structure is uncertain. Two hundred seventy-six subjects (79 normotensive and 197 otherwise healthy hypertensive individuals) underwent echocardiography to assess left ventricular structure. Arterial stiffness was estimated by the pressure-independent stiffness index, beta, and the pressure-dependent elastic modulus derived from simultaneous carotid ultrasound and applanation tonometry. Systemic arterial compliance (the inverse of stiffness) was estimated by the arterial compliance index. In multivariate analysis, beta was related to age (P<0.001) and smoking history (P<0.01) but not mean pressure, whereas elastic modulus was related to age and mean pressure (both P<0.001). The arterial compliance index was only related to age. Whereas systolic and diastolic pressures and the elastic modulus were positively associated with left ventricular mass (all P<0.001), primarily because of increases in wall thicknesses, beta and the arterial compliance index bore no relation to left ventricular mass. beta was inversely related to chamber diameter and directly related to left ventricular relative wall thickness, the ratio of wall thickness to chamber radius. Younger and older hypertensive subjects had comparable left ventricular mass, despite higher systolic and pulse pressures in the older group, whereas older hypertensives had higher mean relative wall thickness, associated with a significant increase in arterial stiffness (beta, 7.06 versus 5.17; elastic modulus, 595 versus 437 dyne/cm(2) x10(-6)) and reduction in the arterial compliance index (0.87 versus 1.05 mL/mm Hg per square meter) (all P<0.001). Thus, the extent to which arterial stiffness relates to left ventricular hypertrophy is dependent on the method by which arterial stiffness is estimated. Pressure-dependent methods show an association with left ventricular hypertrophy, whereas the pressure-independent stiffness index, beta, and the arterial compliance index are most strongly associated with aging and left ventricular concentric remodeling but not hypertrophy.

Aged↗
PubMed2000

Relation of left ventricular chamber and midwall function to age in normal children, adolescents and adults.

BACKGROUND: The goal of this study was to identify the effect of body growth and aging, and normal limits of the relation of left ventricular endocardial and midwall shortening to wall stress. METHODS: Endocardial and midwall shortening and circumferential end-systolic stress were assessed in 388 normotensive, normal-weight adults (226 men, 162 women, age 18 to 85 years) and 332 children and adolescents (180 males, 152 females, age 4 to 17 years) by two-dimensional targeted M-mode echocardiography and cuff blood pressure measurements. RESULTS: End-systolic stress decreased with age in children and adolescents (p < 0.001), but not during adulthood and maturity. The negative relation of endocardial shortening to end-systolic stress was stronger in adults than in children and adolescents (slope difference p < 0.005). The negative relation of midwall shortening to end-systolic stress was negligible in children and adolescents (r = -0.07, p = 0.18), whereas it was more evident, although weak, in adults (r = -0.14, p < 0.007). For a given level of end-systolic stress, endocardial shortening decreased by 0.32%/year in children and adolescents (multiple r = 0.51, p < 0.0001) and by 0.05%/year in adults, whereas midwall shortening decreased by 0.26%/year during body growth and by 0.02%/year in adults. CONCLUSIONS: In the presence of normal blood pressure and normal weight, the relations between left ventricular wall stress and both chamber and myocardial function are weakly but significantly influenced by age. Left ventricular chamber function is markedly influenced by wall stress, while this influence is reduced for left ventricular wall mechanics.

Adolescent↗
PubMed2000

Prevalence of dyslexia among Texas prison inmates.

Approximately 80% of prison inmates are reported to be functionally illiterate. We hypothesized that poor single word decoding (the chief feature of dyslexia) accounts for a significant percentage of that rate. We studied 253 subjects selected randomly from more than 130,000 Texas prison inmates. Among them, we conducted a cross-sectional sample survey of recently admitted Texas inmates, beginning with social and educational background and followed by an educational test battery that included measures of word attack skill and reading comprehension. Deficient performance was defined primarily as single word decoding performance that measured below the 25th percentile on the Woodcock Reading Mastery Test. We found that 47.8% of the inmates were deficient in word attack skills. Word attack skills were detected in each group defined by gender and ethnicity. Nearly two thirds of the subjects scored poorly in reading comprehension.

Adolescent↗
PubMed1999

Cardiac and arterial target organ damage in adults with elevated ambulatory and normal office blood pressure.

BACKGROUND: Ambulatory blood pressure may be higher or lower than clinic blood pressure. Attention has focused on "white coat hypertension" (normal ambulatory blood pressure elevated in the clinic). The converse phenomenon of high ambulatory blood pressure but normal office blood pressure-"white coat normotension"-has not been studied. OBJECTIVE: To assess whether white coat normotension (awake ambulatory blood pressure > 134/90 mm Hg and clinic blood pressure < 140/90 mm Hg) is associated with target organ damage. DESIGN: Cross-sectional observational study. SETTING: University hospital hypertension center and participant work sites. PATIENTS: 295 clinically normotensive adults and 64 patients with sustained hypertension (elevated clinic and ambulatory blood pressure). MEASUREMENTS: Target organ abnormalities were measured by echocardiography and arterial ultrasonography in 61 patients with white coat normotension, 234 with sustained normotension (normal clinic and ambulatory blood pressure), and 64 with sustained hypertension. RESULTS: Patients with white coat normotension were older; had higher body mass indices, serum creatinine concentrations, and glucose levels; and a higher prevalence of current smokers. Left ventricular mass index and relative wall thickness were higher by 13 g/m2 (CI, 8 to 18 g/m2) and by 0.03 (CI, 0.01 to 0.04), respectively, in patients with white coat normotension compared with those who had sustained normotension. Patients with white coat normotension and those with sustained hypertension did not differ significantly for left ventricular mass index (4 g/m2 [CI, - 3 to 10 g/m2) or relative wall thickness (0.01 [CI, -0.01 to 0.03]). The prevalence of discrete atherosclerotic plaques was similar in patients with white coat normotension (17 of 61, or 28% [CI, 17% to 39%]) and those with sustained hypertension (17 of 64, or 27% [CI, 16% to 38%]), but the difference lost significance after adjustment for age. CONCLUSIONS: White coat normotension is associated with left ventricular mass and carotid wall thickness similar to those in sustained hypertension. The association of white coat normotension with prognostically important target organ damage may partly explain the ability of high normal left ventricular mass and high normal clinic blood pressure to predict subsequent hypertension and cardiovascular events in patients with clinical normotension.

Adult↗
PubMed1999

Relations of diastolic left ventricular filling to systolic chamber and myocardial contractility in hypertensive patients with left ventricular hypertrophy (The PRESERVE Study).

Abnormalities of left ventricular (LV) diastolic filling and stress-corrected midwall shortening (MWS) have been described in hypertensive patients with normal ejection fraction (EF). However, whether stress-corrected MWS parallels LV diastolic filling better than EF does remains uncertain. Blood pressure, body mass index, echocardiographic LV mass and LV geometry, EF and stress-corrected MWS, LV diastolic filling (peak E- and A-wave velocities, E-wave deceleration time, and atrial filling fraction) were evaluated in 212 hypertensive patients with LV hypertrophy enrolled in the Prospective Randomized Enalapril Study Evaluating Regression of Ventricular Enlargement study. LV structure, geometry, as well as LV diastolic filling, were compared between patients with reduced EF (<55%, n = 39, 18%) and those with normal EF (>55%) as well as between patients with reduced stress-corrected MWS (<89.2%, n = 31, 15%) and those with normal stress-corrected MWS (>89.2%). Patients with reduced EF had higher LV mass, eccentric LV geometry, and higher heart rate than those with normal EF, although they did not differ in age, blood pressure, or body mass index. LV filling pattern was also similar in those 2 groups. Patients with reduced stress-corrected MWS had higher atrial filling fraction, body mass index, heart rate, LV mass, and concentric geometry than those with normal stress-corrected MWS. Atrial filling fraction was negatively associated with stress-corrected MWS, but not with EF in multivariate models, independently of age, gender, heart rate, and body mass index. Thus, in hypertensive patients with LV hypertrophy, abnormal LV diastolic filling is more closely related to impaired myocardial contractility than to LV chamber EF.

Aged↗
PubMed1999

Phenotypic features and impact of beta blocker or calcium antagonist therapy on aortic lumen size in the Marfan syndrome.

Systematic, prospective data regarding phenotypic features, including echocardiographic findings, in pediatric patients with the Marfan syndrome are lacking. In addition, limited and conflicting information exists regarding the impact of pharmacologic therapy on aortic growth rate in children. Fifty-three children and adolescents with the Marfan syndrome underwent physical examination, anthropometric evaluation, and echocardiography. The relation of pharmacologic therapy to aortic growth rate was examined in the 44 subjects in whom serial echocardiograms were recorded. Although boys and girls did not differ in ocular, skeletal, or cardiovascular manifestations, aortic dilatation tended to be more common in boys (86% vs 72%). Children with aortic dilatation at baseline (42 of 53 or 79%) were more likely to also have scoliosis and mitral prolapse (both p <0.005). The medicated patients had slower aortic growth than the unmedicated patients with regard to both absolute aortic growth rate (p <0.01) and aortic growth rate adjusted for age and body size (p <0.005). Nevertheless, major cardiovascular complications developed in 5 patients despite long-term pharmacologic therapy. In conclusion, beta-blocker and calcium antagonist therapy retards aortic growth rate in children and adolescents with the Marfan syndrome.

Adolescent↗
PubMed1999

Left ventricular chamber and wall mechanics in the presence of concentric geometry.

BACKGROUND: To test the hypothesis that in the presence of left ventricular concentric geometry the definition of 'normal' ejection fraction should be reconsidered, and normality should rather be considered to have a higher than usual lower limit METHODS: M-mode echocardiographic endocardial shortening (eS) was studied in 148 hypertensive patients with left ventricular concentric geometry (relative wall thickness > or = 0.42), 78 with normal (54 +/- 10 years, 27 women) and 70 with depressed midwall shortening (mS) (53 +/- 10 years, 26 women), based on normal distribution of stress-corrected mS, and compared to a reference adult population of 297 age-matched normal subjects (54 +/- 8 years, 121 women) with eS > or = 28%. RESULTS: Patients with low mS exhibited higher heart rates and body mass indices than control individuals (both P < 0.01); blood pressure, left ventricular mass, relative wall thickness and peripheral resistance were higher than in patients with normal mS, whereas cardiac index was reduced (all P< 0.01). Adjustment for body mass index and race attenuated but did not eliminate the differences between the two groups of patients (0.05 < P < 0.0001). In contrast, eS was higher than normal in patients with normal midwall shortening, whereas was 'normal' in patients with low left ventricular midwall function. More than 80% of patients in the lowest quartile of apparently normal eS exhibited clear-cut low left ventricular midwall function. CONCLUSIONS: 'Normal' left ventricular chamber function in the presence of concentric geometry is associated with depressed midwall performance, more severe left ventricular hypertrophy, lower cardiac output and higher peripheral resistance. 'Normal' eS is the hallmark of normal myocardial function when left ventricular geometry is normal, but should be considered as a marker of systolic dysfunction when associated with concentric left ventricular geometry. Normal limits for eS should be therefore reset to upper values.

Adult↗
PubMed1999

Impact of arterial elastance as a measure of vascular load on left ventricular geometry in hypertension.

OBJECTIVE: Effective arterial elastance (Ea), integrating the pulsatile component of left ventricular (LV) afterload, is an estimate of aortic input impedance. We evaluated relationships of Ea with left ventricular anatomy and function in essential hypertension. DESIGN: A cross-sectional analysis in 81 normotensive and 174 untreated hypertensive individuals enrolled in a referral hypertension centre. METHODS: Using echocardiography we determined left ventricular mass index (LVMI), relative wall thickness (RWT), stroke volume (SV), endocardial (FSe) and midwall (FSm) fractional shortening and total peripheral resistance (TPR). Carotid pressure waveforms were obtained by arterial tonometry, and end-systolic pressure (Pes) was measured at the dicrotic notch. Ea index (EaI) was calculated as Pes/(SV index); LV elastance (Ees) was estimated as Pes/LV end-systolic volume, and ventriculo-arterial coupling was evaluated by the Ea/Ees ratio. RESULTS: EaI was higher in hypertensives than in normotensives (3.02 +/- 0.63 versus 2.40 +/- 0.52 mmHg/l per m2; P< 0.0001). Using the 95% upper confidence limit in normotensives, hypertensives were divided in two groups with normal or elevated EaI. The 38 hypertensives with elevated EaI had higher RWT (0.41 +/- 0.06 versus 0.37 +/- 0.05), lower LVMI (87.5 +/- 18.5 versus 96.8 +/- 19.3 g/m2), higher TPR (2247 +/- 408 versus 1658 +/- 371 dynes/cm s(-5)) and lower FSe and FSm (35 +/- 5 versus 39 +/- 5 and 16 +/- 2 versus 18 +/- 2%; all P< 0.05) than patients with normal EaI. Ea/Ees ratio was increased and cardiac output was reduced in hypertensives with elevated EaI. CONCLUSIONS: High values of EaI identify a minority of hypertensive patients characterized by elevated TPR, left ventricular concentric remodelling, depressed left ventricular systolic function and impaired ventriculo-arterial coupling.

Adult↗
PubMed1999

Carotid intimal-medial thickness and stiffness are not affected by hypercholesterolemia in uncomplicated essential hypertension.

The combined effects of hypertension and hypercholesterolemia on carotid anatomy and stiffness were studied in 62 normotensives, 141 uncomplicated essential hypertensives with a total cholesterol level <240 mg/dL, and 60 essential hypertensives with a total cholesterol level >/=240 mg/dL. Carotid ultrasonography was performed to evaluate intimal-medial thickness (IMT), relative wall thickness, and the presence of plaque. Carotid pressure waveforms were recorded by applanation tonometry to measure carotid stiffness (beta) and pressure wave reflection (ie, augmentation index). After adjusting for age, body mass index, and smoking habit by analysis of covariance, no significant differences were found between normocholesterolemic hypertensives and hypercholesterolemic hypertensives in terms of IMT (0.79+/-0.19 versus 0.81+/-0.19 mm), relative wall thickness (0.27+/-0.07 versus 0.28+/-0.07), carotid stiffness (6.1+/-3.2 versus 5.6+/-2.7), augmentation index (18. 7+/-12.9% versus 17.3+/-12.8%), and prevalence of plaque (30.8% versus 30.7%). In the whole population, carotid IMT was significantly related to age (r=0.43), systolic (r=0.35) and diastolic (r=0.35) blood pressures, body surface area (r=0.22), and cholesterol levels (r=0.22) (all P<0.05). Carotid stiffness was significantly related to age, blood pressure, body mass index, and body surface area but not to cholesterol levels. In multivariate analyses, age, body surface area, and systolic blood pressure, but not cholesterol, smoking habit, or sex, were independent correlates of IMT (multiple R=0.54, P<0.0001), whereas carotid stiffness was independently associated with age, body surface area, and sex (R=0. 38, P<0.0001). In conclusion, hypertension is a potent stimulus of vascular hypertrophy. The superimposition of hypercholesterolemia does not substantially augment these changes or further increase arterial stiffness in uncomplicated hypertensive subjects.

Adult↗
PubMed1999

Assessment of arterial compliance by carotid midwall strain-stress relation in normotensive adults.

Examining left ventricular midwall as opposed to endocardial mechanics enhances understanding of left ventricular function in individuals with abnormal cardiac geometry. Accordingly, we used carotid ultrasound and applanation tonometry of arterial pressure to derive carotid midwall strain and its relation to carotid peak-systolic and end-diastolic stresses in 82 apparently normal, employed subjects (56 men, 26 women; median age, 47 years; 70% white; 21% overweight) with no evidence of coronary or valvular heart disease. Regression equations relating carotid luminal and midwall strain to the increment in carotid stress during systole (Deltacarotid stress) were used to predict strain for the observed Deltastress. Observed/predicted carotid luminal or midwall strain was calculated as a measure of carotid luminal or midwall strain for imposed stress, termed stress-corrected strain. Midwall carotid strain was similar in women and men but was negatively related to older age (r=-0.35, P=0.001) and higher body mass index (r=-0.31, P=0.005) and brachial and carotid blood pressure (r=-0.30 to -0.45, all P<0.01). The pulsatile change in arterial load, measured by Deltacarotid stress, was positively related to midwall strain (r=0. 44, P<0.001) more closely than was carotid luminal strain. Regression analyses revealed that carotid midwall strain was positively related to Deltastress, with additional negative relations to age and carotid diastolic diameter (all P<0.001). Stress-corrected carotid midwall strain was strongly and negatively correlated with midwall elastic modulus and Young's modulus (both r=-0.77, P<0.001), followed by elastic modulus (r=-0.74, P<0.001), midwall Young's modulus (r=-0.73, P<0.001), midwall stiffness index (r=-0.70, P<0.001), and stiffness index (r=-0.66, P<0.001). Thus, in normal adults, carotid midwall strain is unrelated to gender, is positively related to pulsatile carotid load as measured by Deltacarotid stress, and is negatively related to age, overweight, and standard measures of arterial stiffness.

Age Factors↗
PubMed1999

Assessment of arterial compliance by carotid midwall strain-stress relation in hypertension.

To elucidate the relations between arterial hypertrophy and compliance in hypertension, we studied 205 unmedicated hypertensive patients (129 men and 76 women) and 82 normotensive adults (56 men and 26 women) from an employed population by carotid ultrasound, noninvasive applanation tonometry, and echocardiography. Carotid midwall strain and circumferential stress were calculated at end diastole and peak systole. The relations of luminal and midwall strain to the increment in circumferential stress from end diastole to peak systole (Deltacarotid stress in normal subjects) were used to calculate ratios of observed/predicted carotid luminal and midwall strain. Mean stress-corrected luminal strain (82+/-26%) and midwall strain (78+/-23%) were lower (both P<0.001) in hypertensive patients than in normal adults. Stress-corrected luminal strain identified 14% of hypertensive patients with low arterial compliance, while stress-corrected midwall strain was low in 18% of patients. Patients with subnormal carotid midwall strain were older (61+/-12 versus 54+/-12 years, P<0.01) and had larger carotid diameters (6. 6+/-0.8 versus 5.7+/-0.8 mm, P=0.002) and higher brachial pulse pressures (71+/-25 versus 63+/-17 mm Hg, P<0.05) than other patients. Patients with arterial hypertrophy had lower stress-corrected midwall strain than those without hypertrophy (70+/-24% versus 79+/-23%, P=0.05), whereas no difference was observed in stress-corrected luminal strain (P=0.40). Stress-corrected midwall strain tended to be lower in patients with discrete atherosclerotic plaques than in those without (74+/-20% versus 79+/-24%, P=0.15). Compared with patients with normal left ventricular geometry, those with concentric hypertrophy had larger carotid diameters (6.6+/-0.7 versus 5.8+/-0.9 mm, P<0.05) and lower stress-corrected luminal strain (62+/-11% versus 85+/-25%, P<0.05) and midwall strain (59+/-10% versus 81+/-22%, P<0.05). Therefore, stress-corrected midwall strain identifies patients with reduced arterial compliance, increased arterial wall thickness, and abnormal left ventricular geometry better than conventional measures based on arterial lumen diameters.

Blood Pressure↗
PubMed1999

Stroke volume/pulse pressure ratio and cardiovascular risk in arterial hypertension.

Ratio of stroke volume (SV, M-mode echocardiography) to pulse pressure (PP) has been proposed as an estimate of total arterial compliance and has been shown to be related to body size, age, and heart rate in normal adults. SV/PP was estimated in 294 hypertensive patients (98 women) as a raw value by use of SV/body surface area (SVi) and by the ratio of SV/PP to the value predicted by a previously developed equation (%SV/PP). At baseline, the 50 patients who had cardiovascular events over the following 10 years exhibited higher PP and lower SV/PP, SVi/PP, and %SV/PP (all P<0.008) than patients without events. Crude risk of follow-up total and fatal cardiovascular events increased with increasing level of PP and decreasing SV/PP, SVi/PP, and %SV/PP (all P<0.002). In multivariate logistic regression models with continuous covariates, the risk of total cardiovascular events was independently related to increasing age (P<0.0001) and left ventricular (LV) mass index (P<0.003) and decreasing values of %SV/PP (P<0.006) but not to increasing systolic, pulse, or mean blood pressure or gender. Similar although less strong results were obtained with the use of SVi/PP (P<0.02), whereas SV/PP did not enter the model as an independent predictor. Risk of cardiovascular death was only predicted by age and LV mass index. The %SV/PP was also an independent predictor of total cardiovascular events in Cox proportional hazards analysis (exp[b]: 2.49, P<0.001) independent of age (exp[b]: 1.05, P<0.003) and LV mass index (exp[b]: 1.02, P<0.0003), whereas no effect was detected for height. Thus, in patients with arterial hypertension, a reduced ratio of M-mode echocardiographic SV/PP as a percentage of the value predicted by demographic variables is a predictor of cardiovascular morbid events independent of age and LV mass index.

Age Factors↗
PubMed1999

Ambulatory blood pressure and metabolic abnormalities in hypertensive subjects with inappropriately high left ventricular mass.

Appropriateness of left ventricular (LV) mass to cardiac workload can be evaluated by the ratio of observed LV mass to the value predicted for an individual's gender, height(2.7), and stroke work at rest (%PLVM). It is unclear which pathophysiological factors are associated with inappropriately high LV mass in hypertensive subjects. Adequate LV mass was defined by the 90% confidence interval (73% to 128%) of the distribution of %PLVM in 393 normal-weight normotensive subjects. In 185 hypertensive subjects (aged 56+/-11 years; 60% male, 29% black), according to %PLVM, 164 (88%) had adequate LV mass, 16 (9%) had inappropriately high LV mass (%PLVM >128%), and 5 (3%) had %PLVM <73% (low LV mass). Age, gender, smoking habit, proportion of never-treated subjects, total cholesterol, triglycerides, and creatinine levels did not differ significantly between subjects with adequate and inappropriately high LV mass. Body mass index, fasting glucose, and proportion of black subjects were higher (all P<0.05), while HDL cholesterol was lower (P<0.05) in subjects with inappropriately high LV mass. Blood pressure at the echocardiogram was comparable between subjects with adequate and inappropriately high LV mass, but the latter group had higher ambulatory blood pressure (P<0.01). Subjects with inappropriately high LV mass also had higher aortic root dimension and LV relative wall thickness and relatively lower LV systolic performance than those with adequate LV mass (all P<0.001). Larger aortic root diameter and lower systolic function were also found in hypertensive subjects with inappropriate LV hypertrophy compared with those with adequate LV hypertrophy. In an exploratory case-control study that compared subjects with low %PLVM with age-matched counterparts with adequate LV mass, low %PLVM was associated with lower body mass index, more favorable metabolic profile, and higher LV myocardial contractility. Higher body mass index, larger aortic root, and black race were independent correlates of increased %PLVM. Thus, in arterial hypertension, levels of LV mass inappropriately high for gender, cardiac workload, and height(2.7) are associated with higher body mass index, higher ambulatory blood pressure, larger aortic root diameters, and relatively low myocardial contractility.

Adult↗
PubMed1999

Left ventricular hypertrophy in hypertension: stimuli, patterns, and consequences.

Left ventricular (LV) size in childhood closely parallels body size, whereas in adulthood LV mass is increasingly affected by effects of obesity, hypertension, the level of cardiac volume load, and the level of LV myocardial contractility. Recently, additional independent associations of diabetes, arterial structure and function and as yet unknown genes with higher LV mass have been defined; angiotensin II and insulin have also been suggested to be additive stimuli to LV hypertrophy. Consideration of the level of LV mass and of the LV wall thickness/chamber radius ratio (relative wall thickness) has identified four different geometric patterns of LV adaptation to hypertension, including concentric LV hypertrophy (increased mass and wall thickness), eccentric hypertrophy (increased mass, normal relative wall thickness), concentric remodeling (increased relative wall thickness with normal mass) and normal LV geometry. Concentric hypertrophy is associated with especially high arterial pressure while eccentric hypertrophy is associated with obesity and elevated volume load. Numerous studies show that increased LV mass predicts cardiovascular events and death independently of all conventional risk factors; initial studies have also identified adverse implications of low LV midwall function and high relative wall thickness. Pioneer studies strongly suggest that reversal of LV hypertrophy is associated with an improved prognosis.

Blood Pressure↗
PubMed1998

Relations of left ventricular mass to fat-free and adipose body mass: the strong heart study. The Strong Heart Study Investigators.

BACKGROUND: It is unclear whether increased left ventricular (LV) mass in overweight individuals is related to their adiposity or to greater fat-free mass (FFM). METHODS AND RESULTS: We compared echocardiographic LV mass to FFM and adipose body mass by bioelectric impedance and to anthropometric measurements in 3107 American Indian participants in the Strong Heart Study. In men and women, the relations of LV mass and FFM (r=0.37 and 0.38, P<0.001) were closer (P<0.05 to <0.001) than they were with adipose mass, waist/hip ratio, body mass index, systolic blood pressure, height, or height2.7. Regression analyses showed that in men LV mass had the strongest independent relation with FFM, followed by systolic blood pressure and age (all P<0.001); in women, LV mass was related to FFM more strongly than it was to systolic blood pressure, age (all P<0. 001), and diabetes (P=0.012). Adipose mass had no independent relation to LV mass. When waist/hip ratio or body mass index were substituted for adipose mass, LV mass was independently related to FFM (P<0.001) and body mass index (P=0.02) but not to waist/hip ratio in men and was independently related to FFM and waist/hip ratio (both P<0.001) but not to body mass index in women. Using 97.5 percentile gender-specific partitions for LV mass/FFM in reference individuals, we found that LV hypertrophy occurred in 20.8% of Strong Heart Study participants with hypertension, overweight, or diabetes compared with 10.5% and 16.7% by LV mass indexed for body surface area or height2.7. CONCLUSIONS: LV mass is more strongly related to FFM than to adipose mass, waist/hip ratio, body mass index, or height-based surrogates for lean body weight; LV mass/FFM criteria may increase sensitivity to detect LV hypertrophy.

Adipose Tissue↗
PubMed1998

A family study of anterior mitral leaflet thickness and mitral valve prolapse.

To determine whether mitral valve prolapse (MVP) with or without mitral leaflet thickening (> or =5 mm) represents distinct heritable conditions, 13 patients with MVP with leaflet thickening and their relatives were compared with 67 patients with MVP with normal leaflets and their relatives. The 2 groups of relatives had similar mitral leaflet thicknesses and similar long-term outcome, arguing against the existence of a distinctive subtype of MVP characterized by increased mitral leaflet thickness.

Adult↗