Pandey A, et al. - Among African Americans, researchers assessed the contributions of left ventricular hypertrophy (LVH) and subclinical myocardial injury as determined by abnormal high-sensitivity cardiac troponin-I (hs-cTnI) measurements toward heart failure (HF) risk. In African Americans, the combination of LVH and subclinical myocardial injury identifies a malignant, preclinical HF phenotype with a very high risk of HF, especially among men. Among people with both LVH and myocardial injury, the highest risk of HF was seen.

Methods

• It was a prospective, community-based cohort study.
• This investigation was conducted between July 2016 and September 2018 and involved African American participants from Jackson, Mississippi enrolled in the Jackson Heart Study without prevalent HF who had hs-cTnI measurements and an echocardiographic examination at baseline.
• Based on the presence or absence of LVH and subclinical myocardial injury, participants were stratified into 3 categories (category 1: hs-cTnI < 4 ng/L in women and <6 ng/L in men; category 2: 4-10 ng/L in women and 6-12 ng/L in men; category 3: >10 ng/L in women and >12 ng/L in men).
• Using Cox proportional hazards models, adjusted associations between LVH, subclinical myocardial injury, and the risk of incident HF hospitalization were evaluated.

Results

• Three thousand, nine hundred eighty-seven participants (2552 women [64%]; 240 (6.0%) with LVH; 1003 (25.1%) with myocardial injury) with 285 incident HF events over a median follow-up of 9.8 years (interquartile range, 8.9-10.6 years) were included.
• Higher LV mass and subclinical myocardial injury were independently associated with the risk of HF with a significant interaction between the 2 (Pint < 0.001) in adjusted analyses.
• Among individuals with both LVH and myocardial injury (absolute incidence, 35%; adjusted hazard ratio [aHR; vs no LVH and no myocardial injury], 5.35; 95% CI, 3.66-7.83), the highest risk of HF was noted.
• A significant interaction was also observed by sex.
• It was noted that men with LVH and subclinical myocardial injury had an almost 15-fold higher risk of HF (aHR, 14.62; 95% CI, 7.61-28.10) compared to those with neither LVH nor injuries.
• By contrast, women with this phenotype were an almost 4-fold higher risk of HF (aHR, 3.81; 95% CI, 2.40-6.85).