title: Resistive and pulsatile arterial load as predictors of left ventricular mass and geometry: the multi-ethnic study of atherosclerosis.
abstract: Arterial load is composed of resistive and various pulsatile components, but their relative contributions to left ventricular (LV) remodeling in the general population are unknown. We studied 4145 participants enrolled in the Multi-Ethnic Study of Atherosclerosis, who underwent cardiac MRI and radial arterial tonometry. We computed systemic vascular resistance (SVR=mean arterial pressure/cardiac output) and indices of pulsatile load including total arterial compliance (TAC, approximated as stroke volume/central pulse pressure), forward wave amplitude (Pf), and reflected wave amplitude (Pb). TAC and SVR were adjusted for body surface area to allow for appropriate sex comparisons. We performed allometric adjustment of LV mass for body size and sex and computed standardized regression coefficients (β) for each measure of arterial load. In multivariable regression models that adjusted for multiple confounders, SVR (β=0.08; P<0.001), TAC (β=0.44; P<0.001), Pb (β=0.73; P<0.001), and Pf (β=-0.23; P=0.001) were significant independent predictors of LV mass. Conversely, TAC (β=-0.43; P<0.001), SVR (β=0.22; P<0.001), and Pf (β=-0.18; P=0.004) were independently associated with the LV wall/LV cavity volume ratio. Women demonstrated greater pulsatile load than men, as evidenced by a lower indexed TAC (0.89 versus 1.04 mL/mm Hg per square meter; P<0.0001), whereas men demonstrated a higher indexed SVR (34.0 versus 32.8 Wood Units×m2; P<0.0001). In conclusion, various components of arterial load differentially associate with LV hypertrophy and concentric remodeling. Women demonstrated greater pulsatile load than men. For both LV mass and the LV wall/LV cavity volume ratio, the loading sequence (ie, early load versus late load) is an important determinant of LV response to arterial load.
authors.affiliation: From the Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine and Philadelphia VA Medical Center (P.Z., V.A.F., J.A.C.); National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD (D.A.B.); Departments of Radiology and Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (D.A.B.); Division of Epidemiology and Community Health (D.R.J., P.H.) and Division of Cardiology (D.A.D.), School of Medicine, University of Minnesota, Minneapolis; Department of Biostatistics, School of Public Health, University of Washington, Seattle (R.K.); Division of Cardiovascular Medicine, The Ohio State University Heart and Vascular Center, Columbus (S.M.L.); Division of Nephrology/Hypertension, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (J.A.L.); Los Angeles Biomedical Research Institute, Torrance, CA (M.B.); and Biofluid, Tissue, and Solid Mechanics for Medical Applications, IBiTech, iMinds Medical IT, Ghent University, Ghent, Belgium (P.S.). pzamani@upenn.edu.
authors.forename: Payman
authors.initials: P
authors.lastname: Zamani
authors.affiliation: From the Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine and Philadelphia VA Medical Center (P.Z., V.A.F., J.A.C.); National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD (D.A.B.); Departments of Radiology and Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (D.A.B.); Division of Epidemiology and Community Health (D.R.J., P.H.) and Division of Cardiology (D.A.D.), School of Medicine, University of Minnesota, Minneapolis; Department of Biostatistics, School of Public Health, University of Washington, Seattle (R.K.); Division of Cardiovascular Medicine, The Ohio State University Heart and Vascular Center, Columbus (S.M.L.); Division of Nephrology/Hypertension, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (J.A.L.); Los Angeles Biomedical Research Institute, Torrance, CA (M.B.); and Biofluid, Tissue, and Solid Mechanics for Medical Applications, IBiTech, iMinds Medical IT, Ghent University, Ghent, Belgium (P.S.).
authors.forename: David A
authors.initials: DA
authors.lastname: Bluemke
authors.affiliation: From the Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine and Philadelphia VA Medical Center (P.Z., V.A.F., J.A.C.); National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD (D.A.B.); Departments of Radiology and Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (D.A.B.); Division of Epidemiology and Community Health (D.R.J., P.H.) and Division of Cardiology (D.A.D.), School of Medicine, University of Minnesota, Minneapolis; Department of Biostatistics, School of Public Health, University of Washington, Seattle (R.K.); Division of Cardiovascular Medicine, The Ohio State University Heart and Vascular Center, Columbus (S.M.L.); Division of Nephrology/Hypertension, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (J.A.L.); Los Angeles Biomedical Research Institute, Torrance, CA (M.B.); and Biofluid, Tissue, and Solid Mechanics for Medical Applications, IBiTech, iMinds Medical IT, Ghent University, Ghent, Belgium (P.S.).
authors.forename: David R
authors.initials: DR
authors.lastname: Jacobs
authors.affiliation: From the Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine and Philadelphia VA Medical Center (P.Z., V.A.F., J.A.C.); National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD (D.A.B.); Departments of Radiology and Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (D.A.B.); Division of Epidemiology and Community Health (D.R.J., P.H.) and Division of Cardiology (D.A.D.), School of Medicine, University of Minnesota, Minneapolis; Department of Biostatistics, School of Public Health, University of Washington, Seattle (R.K.); Division of Cardiovascular Medicine, The Ohio State University Heart and Vascular Center, Columbus (S.M.L.); Division of Nephrology/Hypertension, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (J.A.L.); Los Angeles Biomedical Research Institute, Torrance, CA (M.B.); and Biofluid, Tissue, and Solid Mechanics for Medical Applications, IBiTech, iMinds Medical IT, Ghent University, Ghent, Belgium (P.S.).
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Duprez
authors.affiliation: From the Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine and Philadelphia VA Medical Center (P.Z., V.A.F., J.A.C.); National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD (D.A.B.); Departments of Radiology and Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (D.A.B.); Division of Epidemiology and Community Health (D.R.J., P.H.) and Division of Cardiology (D.A.D.), School of Medicine, University of Minnesota, Minneapolis; Department of Biostatistics, School of Public Health, University of Washington, Seattle (R.K.); Division of Cardiovascular Medicine, The Ohio State University Heart and Vascular Center, Columbus (S.M.L.); Division of Nephrology/Hypertension, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (J.A.L.); Los Angeles Biomedical Research Institute, Torrance, CA (M.B.); and Biofluid, Tissue, and Solid Mechanics for Medical Applications, IBiTech, iMinds Medical IT, Ghent University, Ghent, Belgium (P.S.).
authors.forename: Richard
authors.initials: R
authors.lastname: Kronmal
authors.affiliation: From the Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine and Philadelphia VA Medical Center (P.Z., V.A.F., J.A.C.); National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD (D.A.B.); Departments of Radiology and Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (D.A.B.); Division of Epidemiology and Community Health (D.R.J., P.H.) and Division of Cardiology (D.A.D.), School of Medicine, University of Minnesota, Minneapolis; Department of Biostatistics, School of Public Health, University of Washington, Seattle (R.K.); Division of Cardiovascular Medicine, The Ohio State University Heart and Vascular Center, Columbus (S.M.L.); Division of Nephrology/Hypertension, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (J.A.L.); Los Angeles Biomedical Research Institute, Torrance, CA (M.B.); and Biofluid, Tissue, and Solid Mechanics for Medical Applications, IBiTech, iMinds Medical IT, Ghent University, Ghent, Belgium (P.S.).
authors.forename: Scott M
authors.initials: SM
authors.lastname: Lilly
authors.affiliation: From the Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine and Philadelphia VA Medical Center (P.Z., V.A.F., J.A.C.); National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD (D.A.B.); Departments of Radiology and Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (D.A.B.); Division of Epidemiology and Community Health (D.R.J., P.H.) and Division of Cardiology (D.A.D.), School of Medicine, University of Minnesota, Minneapolis; Department of Biostatistics, School of Public Health, University of Washington, Seattle (R.K.); Division of Cardiovascular Medicine, The Ohio State University Heart and Vascular Center, Columbus (S.M.L.); Division of Nephrology/Hypertension, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (J.A.L.); Los Angeles Biomedical Research Institute, Torrance, CA (M.B.); and Biofluid, Tissue, and Solid Mechanics for Medical Applications, IBiTech, iMinds Medical IT, Ghent University, Ghent, Belgium (P.S.).
authors.forename: Victor A
authors.initials: VA
authors.lastname: Ferrari
authors.affiliation: From the Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine and Philadelphia VA Medical Center (P.Z., V.A.F., J.A.C.); National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD (D.A.B.); Departments of Radiology and Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (D.A.B.); Division of Epidemiology and Community Health (D.R.J., P.H.) and Division of Cardiology (D.A.D.), School of Medicine, University of Minnesota, Minneapolis; Department of Biostatistics, School of Public Health, University of Washington, Seattle (R.K.); Division of Cardiovascular Medicine, The Ohio State University Heart and Vascular Center, Columbus (S.M.L.); Division of Nephrology/Hypertension, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (J.A.L.); Los Angeles Biomedical Research Institute, Torrance, CA (M.B.); and Biofluid, Tissue, and Solid Mechanics for Medical Applications, IBiTech, iMinds Medical IT, Ghent University, Ghent, Belgium (P.S.).
authors.forename: Raymond R
authors.initials: RR
authors.lastname: Townsend
authors.affiliation: From the Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine and Philadelphia VA Medical Center (P.Z., V.A.F., J.A.C.); National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD (D.A.B.); Departments of Radiology and Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (D.A.B.); Division of Epidemiology and Community Health (D.R.J., P.H.) and Division of Cardiology (D.A.D.), School of Medicine, University of Minnesota, Minneapolis; Department of Biostatistics, School of Public Health, University of Washington, Seattle (R.K.); Division of Cardiovascular Medicine, The Ohio State University Heart and Vascular Center, Columbus (S.M.L.); Division of Nephrology/Hypertension, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (J.A.L.); Los Angeles Biomedical Research Institute, Torrance, CA (M.B.); and Biofluid, Tissue, and Solid Mechanics for Medical Applications, IBiTech, iMinds Medical IT, Ghent University, Ghent, Belgium (P.S.).
authors.forename: Joao A
authors.initials: JA
authors.lastname: Lima
authors.affiliation: From the Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine and Philadelphia VA Medical Center (P.Z., V.A.F., J.A.C.); National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD (D.A.B.); Departments of Radiology and Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (D.A.B.); Division of Epidemiology and Community Health (D.R.J., P.H.) and Division of Cardiology (D.A.D.), School of Medicine, University of Minnesota, Minneapolis; Department of Biostatistics, School of Public Health, University of Washington, Seattle (R.K.); Division of Cardiovascular Medicine, The Ohio State University Heart and Vascular Center, Columbus (S.M.L.); Division of Nephrology/Hypertension, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (J.A.L.); Los Angeles Biomedical Research Institute, Torrance, CA (M.B.); and Biofluid, Tissue, and Solid Mechanics for Medical Applications, IBiTech, iMinds Medical IT, Ghent University, Ghent, Belgium (P.S.).
authors.forename: Matthew
authors.initials: M
authors.lastname: Budoff
authors.affiliation: From the Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine and Philadelphia VA Medical Center (P.Z., V.A.F., J.A.C.); National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD (D.A.B.); Departments of Radiology and Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (D.A.B.); Division of Epidemiology and Community Health (D.R.J., P.H.) and Division of Cardiology (D.A.D.), School of Medicine, University of Minnesota, Minneapolis; Department of Biostatistics, School of Public Health, University of Washington, Seattle (R.K.); Division of Cardiovascular Medicine, The Ohio State University Heart and Vascular Center, Columbus (S.M.L.); Division of Nephrology/Hypertension, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (J.A.L.); Los Angeles Biomedical Research Institute, Torrance, CA (M.B.); and Biofluid, Tissue, and Solid Mechanics for Medical Applications, IBiTech, iMinds Medical IT, Ghent University, Ghent, Belgium (P.S.).
authors.forename: Patrick
authors.initials: P
authors.lastname: Segers
authors.affiliation: From the Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine and Philadelphia VA Medical Center (P.Z., V.A.F., J.A.C.); National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD (D.A.B.); Departments of Radiology and Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (D.A.B.); Division of Epidemiology and Community Health (D.R.J., P.H.) and Division of Cardiology (D.A.D.), School of Medicine, University of Minnesota, Minneapolis; Department of Biostatistics, School of Public Health, University of Washington, Seattle (R.K.); Division of Cardiovascular Medicine, The Ohio State University Heart and Vascular Center, Columbus (S.M.L.); Division of Nephrology/Hypertension, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (J.A.L.); Los Angeles Biomedical Research Institute, Torrance, CA (M.B.); and Biofluid, Tissue, and Solid Mechanics for Medical Applications, IBiTech, iMinds Medical IT, Ghent University, Ghent, Belgium (P.S.).
authors.forename: Peter
authors.initials: P
authors.lastname: Hannan
authors.affiliation: From the Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine and Philadelphia VA Medical Center (P.Z., V.A.F., J.A.C.); National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD (D.A.B.); Departments of Radiology and Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (D.A.B.); Division of Epidemiology and Community Health (D.R.J., P.H.) and Division of Cardiology (D.A.D.), School of Medicine, University of Minnesota, Minneapolis; Department of Biostatistics, School of Public Health, University of Washington, Seattle (R.K.); Division of Cardiovascular Medicine, The Ohio State University Heart and Vascular Center, Columbus (S.M.L.); Division of Nephrology/Hypertension, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (J.A.L.); Los Angeles Biomedical Research Institute, Torrance, CA (M.B.); and Biofluid, Tissue, and Solid Mechanics for Medical Applications, IBiTech, iMinds Medical IT, Ghent University, Ghent, Belgium (P.S.).
authors.forename: Julio A
authors.initials: JA
authors.lastname: Chirinos
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000175:diagnosis / Q000208:ethnology / Q000503:physiopathology*; D001794:Blood Pressure / Q000502:physiology*; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011673:Pulsatile Flow / Q000502:physiology*; D012189:Retrospective Studies; D013318:Stroke Volume; D014481:United States / Q000453:epidemiology; D014655:Vascular Resistance / Q000502:physiology*; D016277:Ventricular Function, Left / Q000502:physiology*; D020257:Ventricular Remodeling / Q000502:physiology
keywords: hypertrophy, left ventricular; vascular resistance; ventricular remodeling