03118nas a2200373 4500008004100000022001400041245012600055210006900181260001700250300001000267490000600277520203200283653002802315653003002343653002102373653002102394653003002415653001102445653002402456653002002480653001702500653001802517100001602535700001502551700001402566700002302580700001602603700001702619700001702636700001902653700002002672700001702692856003502709 1992 eng d a0894-731700aEchocardiographic design of a multicenter investigation of free-living elderly subjects: the Cardiovascular Health Study.0 aEchocardiographic design of a multicenter investigation of freel c1992 Jan-Feb a63-720 v53 a

The Framingham study has shown by M-mode echocardiography that left ventricular hypertrophy is a powerful, independent predictor for the development of coronary heart disease and that increased left atrial dimension has been associated with an increased risk of stroke. No previous population-based study has evaluated the risk factor correlates and predictive value for coronary heart disease and stroke of two-dimensional and Doppler, as well as M-mode, echocardiography. The Cardiovascular Health Study is a multi-year prospective epidemiologic study of 5201 men and women older than 65 recruited from four geographic sites in the United States. The main objectives of incorporating echocardiography were to determine whether echocardiographic indices, or changes in these indices, are (1) correlated with traditional risk factors for coronary heart disease and stroke; and (2) independent predictors of morbidity and mortality for coronary heart disease and stroke. Echocardiographic measurements of interest include those related to global and segmental left ventricular systolic and diastolic structure and function and left atrial size. For each subject, a baseline echocardiogram was recorded in super-VHS tape using a standard protocol and equipment. All studies were sent to a reading center where images were digitized and measurements were made using customized computer algorithms. Calculated data and images were stored on optical disks to facilitate retrieval and future comparisons in longitudinal studies. A second echocardiogram is scheduled in year 7, with a goal of determining whether changes in cardiac anatomy or function over a 5-year period are important predictors of morbidity or mortality from coronary heart disease and stroke. Quality control measures included standardized training of echocardiography technicians and readers, technician observation by a trained echocardiographer, periodic blind duplicate readings with reader review sessions, phantom studies, and quality control adults.

10aAllied Health Personnel10aCerebrovascular Disorders10aCoronary Disease10aEchocardiography10aEchocardiography, Doppler10aHumans10aProspective Studies10aQuality Control10aRisk Factors10aUnited States1 aGardin, J M1 aWong, N, D1 aBommer, W1 aKlopfenstein, H, S1 aSmith, V, E1 aTabatznik, B1 aSiscovick, D1 aLobodzinski, S1 aAnton-Culver, H1 aManolio, T A uhttps://chs-nhlbi.org/node/95103702nas a2200409 4500008004100000022001400041245015600055210006900211260001600280300001200296490000700308520256000315653001602875653000902891653002202900653001002922653001902932653002102951653002102972653001102993653001103004653003403015653000903049653001603058653001203074100001603086700001703102700002003119700001603139700001603155700002303171700001703194700001303211700001503224700001703239856003603256 1995 eng d a0009-732200aSex, age, and disease affect echocardiographic left ventricular mass and systolic function in the free-living elderly. The Cardiovascular Health Study.0 aSex age and disease affect echocardiographic left ventricular ma c1995 Mar 15 a1739-480 v913 a

BACKGROUND: Left ventricular (LV) hypertrophy, as measured by M-mode echocardiography, is an independent predictor of mortality and/or morbidity from coronary heart disease (CHD). LV global and segmental systolic dysfunction also have been associated with myocardial ischemia and cardiovascular morbidity and mortality. Echocardiographic data, especially two-dimensional, have not been available previously from multicenter-based studies of the elderly. This report describes the distribution and relation at baseline of echocardiographic LV mass and global and segmental LV wall motion to age, sex, and clinical disease category in the Cardiovascular Health Study (CHS), a cohort of 5201 men and women (4850 white) 65 years of age and older.

METHODS AND RESULTS: M-mode LV mass adjusted for body weight increased modestly with age (P < .0001), increasing less than one gram per year increase in age for both men and women. After adjustment for weight, LV mass was significantly greater in men than in women and in participants with clinical CHD compared with participants with neither clinical heart disease nor hypertension (both P < .001). Across all CHS age subgroups, the difference in weight-adjusted LV mass by sex was greater in magnitude than the difference related to clinical CHD. M-mode measurements of LV mass could not be made in 34% of CHS participants, and this was highly related to age (29% in the 65 to 69 year versus 50% in the 85+ year age group, P < .001) and other risk factors. In participants with clinical CHD and with neither clinical heart disease nor hypertension, LV ejection fraction and segmental wall motion abnormalities were more prevalent in men than women (all P < .001). Of interest, 0.5% of men and 0.4% of women with neither clinical heart disease nor hypertension had LV segmental wall motion abnormalities, suggesting silent disease, compared with 26% of men and 10% of women in the clinical CHD group (P < .0001). Multivariate analyses revealed male sex and presence of clinical CHD (both P < .001) to be independent predictors of LV akinesis or dyskinesis.

CONCLUSIONS: Significant baseline relations were detected between differences in sex, prevalent disease status, and echocardiographic measurements of LV mass and systolic function in the CHS cohort. Age was weakly associated with LV mass measurements and LV ejection fraction abnormalities. These relations should be considered in evaluating the preclinical and clinical effects of CHD risk factors in the elderly.

10aAge Factors10aAged10aAged, 80 and over10aAging10aCohort Studies10aCoronary Disease10aEchocardiography10aFemale10aHumans10aHypertrophy, Left Ventricular10aMale10aSex Factors10aSystole1 aGardin, J M1 aSiscovick, D1 aAnton-Culver, H1 aLynch, J, C1 aSmith, V, E1 aKlopfenstein, H, S1 aBommer, W, J1 aFried, L1 aO'Leary, D1 aManolio, T A uhttps://chs-nhlbi.org/node/142202751nas a2200373 4500008004100000022001400041245016800055210006900223260001300292300001100305490000700316520167800323653000902001653001902010653002702029653002802056653002102084653001102105653002102116653001102137653001702148653000902165653001802174653001702192100001602209700001802225700001502243700001702258700001702275700001602292700001602308700001702324856003602341 1996 eng d a0039-249900aCompensatory increase in common carotid artery diameter. Relation to blood pressure and artery intima-media thickness in older adults. Cardiovascular Health Study.0 aCompensatory increase in common carotid artery diameter Relation c1996 Nov a2012-50 v273 a

BACKGROUND AND PURPOSE: Common carotid artery (CCA) diameter is thought to increase as a consequence of hypertension and may increase as the thickness of the arterial wall increases. The purpose of this study was to determine CCA dimensions and correlate them with clinical features.

METHODS: We performed a cross-sectional, community-based study of adults 65 years of age and older, measuring inner and outer diameter of the CCA in vivo with carotid sonography. Findings were correlated against risk factors for atherosclerosis, CCA intima-media thickness (IMT), and echocardiographically determined left ventricular (LV) mass.

RESULTS: Independent variables showing strong positive associations with outer and inner CCA diameter included age, male sex, height, weight, and systolic blood pressure. As an independent variable, LV mass (r = .40 and r = .37, respectively; P < .00001) had a strong positive relation to inner and outer CCA diameters. The relationship between diameter and IMT was different. In a model that controlled for age, sex, and estimated LV mass, an increase of 1 mm in CCA IMT corresponded to a 1.9 mm increase in the outer diameter of the artery (P < .00001) but was not significantly related to the inner diameter (slope = +0.07 mm; P = .26).

CONCLUSIONS: Increase in the outer diameter of the CCA is associated with subject size, sex, age, echocardiographically estimated LV mass, and CCA IMT. Increases in internal diameter of the CCA have similar relationships but are not related to IMT. This supports the hypothesis that the human CCA dilates as the thickness of the artery wall increases.

10aAged10aBlood Pressure10aCarotid Artery, Common10aCross-Sectional Studies10aEchocardiography10aFemale10aHeart Ventricles10aHumans10aHypertension10aMale10aTunica Intima10aTunica Media1 aPolak, J, F1 aKronmal, R, A1 aTell, G, S1 aO'Leary, D H1 aSavage, P, J1 aGardin, J M1 aRutan, G, H1 aBorhani, N O uhttps://chs-nhlbi.org/node/146603068nas a2200433 4500008004100000022001400041245015200055210006900207260001300276300000900289490000700298520186600305653001602171653000902187653002102196653002402217653001102241653001102252653003402263653001802297653000902315653002702324653001202351653001502363653001402378653001702392653001602409653002402425100002102449700001702470700001702487700001502504700001602519700001502535700001702550700001702567700001402584856003602598 1996 eng d a0194-911X00aUtility of new electrocardiographic models for left ventricular mass in older adults. The Cardiovascular Health Study Collaborative Research Group.0 aUtility of new electrocardiographic models for left ventricular  c1996 Jul a8-150 v283 a

Several multivariate statistical models have recently been introduced for estimation of left ventricular mass from standard 12-lead electrocardiographic measurements. The validity of these algorithms has not been adequately evaluated. The objective of this investigation was to compare the associations between echocardiographic and electrocardiographic left ventricular mass values with clinical and subclinical indexes of coronary heart disease. The evaluation was performed with participants of the Cardiovascular Health Study, a population-based sample of 5201 men and women aged 65 years and older. Echocardiographic M-mode measurements of left ventricular mass were performed from videotape recordings with the use of a strictly standardized protocol. Electrocardiographic algorithms of the Novacode program and new algorithms derived from the Cardiovascular Health Study population were used for left ventricular mass prediction. Echocardiographic and electrocardiographic determinations of left ventricular mass were technically successful in 3410 (65.6%) and 5013 (96.4%) participants, respectively. The Novacode model overestimated echocardiographic left ventricular mass. Compared with the Novacode model, the new Cardiovascular Health Study electrocardiographic model, which includes adjustment for body weight, eliminated left ventricular mass prediction bias and improved the correlation between echocardiographic and electrocardiographic left ventricular mass from .33 to .54 in women and from .46 to .51 in men. Echocardiographic and electrocardiographic models both demonstrated similar and about equally strong associations with overt and subclinical disease and with risk factors for left ventricular hypertrophy. These observations demonstrate the potential utility of electrocardiographic models for left ventricular mass estimation.

10aAge Factors10aAged10aEchocardiography10aElectrocardiography10aFemale10aHumans10aHypertrophy, Left Ventricular10aLinear Models10aMale10aModels, Cardiovascular10aObesity10aOdds Ratio10aPrognosis10aRisk Factors10aSex Factors10aVideotape Recording1 aRautaharju, P, M1 aManolio, T A1 aSiscovick, D1 aZhou, S, H1 aGardin, J M1 aKronmal, R1 aFurberg, C D1 aBorhani, N O1 aNewman, A uhttps://chs-nhlbi.org/node/145803351nas a2200373 4500008004100000022001400041245014100055210006900196260001300265300001000278490000800288520229500296653000902591653002402600653001902624653002202643653002102665653001102686653002702697653001102724653000902735653001702744653003002761653003102791100001102822700001602833700001602849700001602865700001502881700001702896700001302913700001502926856003602941 1997 eng d a0002-870300aDiabetes mellitus and echocardiographic left ventricular function in free-living elderly men and women: The Cardiovascular Health Study.0 aDiabetes mellitus and echocardiographic left ventricular functio c1997 Jan a36-430 v1333 a

This report describes the relation among diabetes, blood pressure, and prevalent cardiovascular disease, and echocardiographically measured left ventricular mass and filling (transmitral valve flow) velocities in the Cardiovascular Health Study, a cohort of 5201 men and women > or = 65 years of age. Ventricular septal and left posterior wall thicknesses were greater in diabetic than in nondiabetic subjects, showing a significant linear trend (p = 0.025 for ventricular septal thickness in both sexes combined, p = 0.002 for posterior wall thickness) with increased duration of diabetes. Increased wall thickness of the ventricular septum or the left posterior wall was not associated with prevalent coronary heart disease (CHD) in the cohort. Increased left ventricular mass was associated with diabetic persons not reporting CHD and with all subjects with CHD regardless of glucose tolerance status. After adjusting for body weight, blood pressure, heart rate, and prevalent coronary or cerebrovascular disease, diabetes (as measured by glucose level, insulin use, oral hypoglycemic use, and a positive history of diabetes before baseline examination) remained an independent predictor of increased left ventricular mass among men and women (174.2 gm in diabetic men vs 169.8 gm in normal men, 138.2 gm in diabetic women vs 134.0 gm in normal women, p = 0.043 for both sexes combined). Both early and late diastolic transmitral peak flow velocities were higher with increased duration of diabetes, but the calculated ratio of the early peak flow velocity to the late velocity (E/A ratio) did not differ significantly between subjects with historical diabetes and those with normal fasting glucose (both genders combined, p = 0.190). Glucose level, insulin use, oral hypoglycemic use, and a positive history of diabetes before baseline examination were significant independent predictors of the late transmitral peak flow velocity and its integrated flow-velocity curve but not for the integral of the early peak flow velocity or the E/A ratio. Diabetes is associated with abnormal left ventricular structure and function in elderly persons. This association persists after adjustment for body weight, blood pressure, heart rate, and reported coronary or cerebrovascular disease.

10aAged10aBlood Flow Velocity10aBlood Pressure10aDiabetes Mellitus10aEchocardiography10aFemale10aGlucose Tolerance Test10aHumans10aMale10aMitral Valve10aResidence Characteristics10aVentricular Function, Left1 aLee, M1 aGardin, J M1 aLynch, J, C1 aSmith, V, E1 aTracy, R P1 aSavage, P, J1 aSzklo, M1 aWard, B, J uhttps://chs-nhlbi.org/node/147503691nas a2200409 4500008004100000022001400041245007500055210006900130260001300199300001300212490000700225520259400232653000902826653002202835653001902857653001602876653002802892653001902920653002102939653001102960653001102971653003402982653000903016653002403025653001703049653003103066100001603097700001403113700002003127700001503147700001503162700002303177700001703200700001303217700001503230856003603245 1997 eng d a0194-911X00aLeft ventricular mass in the elderly. The Cardiovascular Health Study.0 aLeft ventricular mass in the elderly The Cardiovascular Health S c1997 May a1095-1030 v293 a

Left ventricular (LV) mass, as estimated from M-mode echocardiography (echo), has previously been shown to be an independent predictor of incident cardiovascular disease morbidity and mortality. We evaluated the relationship at baseline of echo LV mass to relevant cardiovascular disease risk factors and other potential covariates in the Cardiovascular Health Study, multicenter study sponsored by the National Heart, Lung, and Blood Institute of 5201 men and women aged 65 years or older (mean, 73). Two-dimensionally directed M-mode echo LV mass measurements could be obtained in 1357 men and 2053 women (66% of this elderly cohort). Stepwise linear regression analyses of the relationship of echo LV mass to demographic and risk factor, physical activity, electrocardiographic, and prevalent disease variables resulted in a model that explained 37% of the variance for the entire cohort. In order of decreasing importance, factors positively associated with echo LV mass were body weight, male sex, systolic pressure, presence of congestive heart failure, present smoking, major and minor electrocardiographic abnormalities, treatment for hypertension, valvular heart disease, aortic regurgitation by color Doppler, and mitral regurgitation by color Doppler (in men) whereas diastolic pressure, bioresistance (a measure of adiposity), and high-density lipoprotein cholesterol were inversely related to echo LV mass. Although height and weight were both related to LV mass, height added nothing once weight was entered in multiple linear regression analyses. Furthermore, in the multiple regression models, diastolic pressure was inversely and systolic BP positively related to LV mass, with similar magnitudes for their coefficients. In consonance with these findings, pulse pressure was positively related to LV mass in bivariate analyses. Multiple linear regression analyses explained less of the variance for ventricular septal thickness (R2 = .13) and LV posterior wall thickness (R2 = .14) than for LV mass (R2 = .37) and LV diastolic dimension (R2 = .27). Intriguing findings in the elderly Cardiovascular Health Study cohort included the presence of pulse pressure as a positive correlate, and high-density lipoprotein cholesterol as an inverse correlate, of LV mass. Longitudinal studies in the Cardiovascular Health Study cohort will help to clarify the importance of demographic, risk factor, and other variables, and changes in these variables, in predicting changes in echo LV mass and its components as well as the prognostic significance of LV mass in the elderly.

10aAged10aAged, 80 and over10aBlood Pressure10aBody Weight10aCardiovascular Diseases10aCohort Studies10aEchocardiography10aFemale10aHumans10aHypertrophy, Left Ventricular10aMale10aProspective Studies10aRisk Factors10aVentricular Function, Left1 aGardin, J M1 aArnold, A1 aGottdiener, J S1 aWong, N, D1 aFried, L P1 aKlopfenstein, H, S1 aO'Leary, D H1 aTracy, R1 aKronmal, R uhttps://chs-nhlbi.org/node/148003483nas a2200433 4500008004100000022001400041245013200055210006900187260001300256300001300269490000700282520226300289653000902552653002202561653001902583653002102602653001502623653002802638653002102666653001102687653001702698653001102715653001702726653003402743653000902777653002102786653001702807653001802824653001802842653001702860653003102877100001702908700001802925700002002943700001702963700001802980700001602998856003503014 2001 eng d a0263-635200aRelation of hemodynamics and risk factors to ventricular-vascular interactions in the elderly: the Cardiovascular Health Study.0 aRelation of hemodynamics and risk factors to ventricularvascular c2001 Oct a1893-9030 v193 a

OBJECTIVE: To investigate the interaction between left ventricular (LV) geometry, carotid structure and arterial compliance in relation to hemodynamic stimuli and risk factors (plasma cholesterol, body mass index, insulin resistance, smoking habit, age, sex and race).

DESIGN: Cross-sectional.

METHODS: Echocardiography and carotid ultrasound were performed in 2375 elderly subjects without signs or history of prevalent cardiovascular disease, diabetes or renal disease (795 men; 298 non-whites; 1215 hypertensive), from the cohort of the Cardiovascular Health Study. Arterial compliance was estimated by the prognostically validated ratio of stroke volume to pulse pressure (SV/PP) as the percent deviation (Delta%) from the value predicted by individual age, heart rate and body weight.

RESULTS: Intima-medial thickness (IMT) was higher in the presence of LV hypertrophy (LVH) in normotensive and hypertensive subjects and was greatest in the presence of concentric LVH. Maximum carotid lumen diameter (CLD) was also higher in the presence of LVH (and was greatest with eccentric LVH, in association with relatively high values for stroke volume). After adjusting for blood pressure, maximum carotid lumen diameter was directly correlated with stroke volume, and IMT to LV mass (all P < 0.001). Similarly, IMT was also related to maximum carotid lumen diameter, independently of prevalent risk factors (P < 0.001). SV/PP-Delta% was reduced in both groups with concentric LV remodeling (both P < 0.0001) or concentric LVH (both P < 0.05). Adjusting for risk factors did not affect these associations in normotensives, but made them insignificant in hypertensives. In normotensives, IMT was inversely related to SV/PP-Delta% (P < 0.001), independently of risk factors, whereas no significant relation was found in hypertensives.

CONCLUSIONS: The magnitudes of carotid intima-medial thickness and lumen diameter parallel levels of LV mass and geometry, and are directly related to stroke volume and arterial stiffness; this interaction is most evident in the presence of normal blood pressure, whereas it is affected by other cardiovascular risk factors when arterial hypertension is present.

10aAged10aAged, 80 and over10aBlood Pressure10aCarotid Arteries10aCompliance10aCross-Sectional Studies10aEchocardiography10aFemale10aHemodynamics10aHumans10aHypertension10aHypertrophy, Left Ventricular10aMale10aReference Values10aRisk Factors10aStroke Volume10aTunica Intima10aTunica Media10aVentricular Function, Left1 ade Simone, G1 aMcClelland, R1 aGottdiener, J S1 aCelentano, A1 aKronmal, R, A1 aGardin, J M uhttps://chs-nhlbi.org/node/664