Association of comorbidity burden with abnormal cardiac mechanics: findings from the HyperGEN study.
BACKGROUND
Comorbidities are common in heart failure (HF), and the number of comorbidities has been associated with poor outcomes in HF patients. However, little is known about the effect of multiple comorbidities on cardiac mechanics, which could impact the pathogenesis of HF. We sought to determine the relationship between comorbidity burden and adverse cardiac mechanics.


RESULTS
We performed speckle-tracking analysis on echocardiograms from the HyperGEN study (n=2150). Global longitudinal, circumferential, and radial strain, and early diastolic (e') tissue velocities were measured. We evaluated the association between comorbidity number and cardiac mechanics using linear mixed effects models to account for relatedness among subjects. The mean age was 51 ± 14 years, 58% were female, and 47% were African American. Dyslipidemia and hypertension were the most common comorbidities (61% and 58%, respectively). After adjusting for left ventricular (LV) mass index, ejection fraction, and several potential confounders, the number of comorbidities remained associated with all indices of cardiac mechanics except global circumferential strain (eg, β=-0.32 [95% CI -0.44, -0.20] per 1-unit increase in number of comorbidities for global longitudinal strain; β=-0.16 [95% CI -0.20, -0.11] for e' velocity; P ≤ 0.0001 for both comparisons). Results were similar after excluding participants with abnormal LV geometry (P<0.05 for all comparisons).


CONCLUSIONS
Higher comorbidity burden is associated with worse cardiac mechanics, even in the presence of normal LV geometry. The deleterious effect of multiple comorbidities on cardiac mechanics may explain both the high comorbidity burden and adverse outcomes in patients who ultimately develop HF.
Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
Senthil
S
Selvaraj
Frank G
FG
Aguilar
Eva E
EE
Martinez
Lauren
L
Beussink
Kwang-Youn A
KY
Kim
Jie
J
Peng
Laura
L
Rasmussen-Torvik
Jin
J
Sha
Marguerite R
MR
Irvin
C Charles
CC
Gu
Cora E
CE
Lewis
Steven C
SC
Hunt
Donna K
DK
Arnett
Sanjiv J
SJ
Shah
D001741:Black or African American / Q000706:statistics & numerical data; D015897:Comorbidity; D003430:Cross-Sectional Studies; D050171:Dyslipidemias / Q000453:epidemiology; D015150:Echocardiography, Doppler; D005260:Female; D006321:Heart / Q000503:physiopathology; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology; D044465:White People / Q000706:statistics & numerical data
cardiac mechanics; comorbidities; echocardiography; risk factors; strain