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Introduction: Studies in non-Hispanic whites suggest that early adaptive changes in cardiac structure due to hypertension may influence the development of heart failure (HF). The predictive value of left ventricular (LV) structure to incident acute decompensated HF (ADHF) has not been well-studied in African Americans (AA) despite the higher incidence of HF in this group. Hypothesis: We hypothesized that incidence of ADHF in AA varies according to cardiac structures and LV geometry type. Methods: The study sample included 1,737 participants who attended the third examination cycle of the Jackson cohort of ARIC between 1993 and1995 and underwent echocardiography, anthropometry and phlebotomy for glucose and lipids. Left atrial size, aortic root diameter (AOD), LV wall thicknesses and chamber dimensions, LV mass, LV mass index, LV hypertrophy (LVH) and LV geometric patterns [normal geometry, concentric hypertrophy, eccentric hypertrophy (EH), concentric remodeling] were determined by echocardiography. Cutoff for LVH was defined as above the 80th percentile of LV mass index. HF data was available up to December 31, 2011. In the primary analyses we adjusted for age, sex, smoking, diabetes, body mass index, systolic blood pressure, and use of hypertension medications in the multivariable model. Results: Over a follow-up period of approximately 18 years, 188 participants developed ADHF. Incident ADHF was significantly related to AOD [HR 1.42 (1.03, 1.97)], LV internal diameter in diastole (cm) [HR 1.60 (1.24, 2.05)], LV mass [HR 1.003 (1.002, 1.005)], LVM index [HR 1.01 (1.004, 1.02) and LVH [HR 1.62 (1.16, 2.27)]. In terms of LV geometry, EH was significantly related to incident ADHF in the multivariable model [HR 2.94 (1.70-5.10)]. Conclusion: In our large community-based sample of AAs, we observed that AOD, LV internal diameter in diastole, LV mass, LV mass index, LVH and EH geometry were significantly related to long-term incidence of ADHF independent of standard risk factors. These findings suggest echocardiography may be helpful in risk stratifying members of this high risk population for ADHF.

Background: The presence of chronic kidney disease is greater in African Americans than in non-Hispanic whites. Though there is data to show a relation between endothelial dysfunction and end-stage kidney disease, the relation to mild and moderate chronic kidney disease (particularly in African Americans) is unclear. Methods and Results: Digital arterial tonometry was performed during Exam 2 and 3 of the Jackson Heart Study using the endoPAT2000. Data from digital arterial tonometry included baseline pulse wave amplitude (BPA) as a measure of endothelial tone and reactive hyperemic index (F-RHI) as a measure of endothelial function. For this study, the estimated glomerular filtration rate (eGFR) was calculated using the MDRD equation. Those participants with eGFR < 60 ml/min/1.73m2 were defined as having CKD. Participants with eGFR < 15 ml/min/1.73m2 were excluded from the analysis. Microalbuminuria in this study was defined as a urinary albumin:creatinine ratio ≥ 17mg/g in men and ≥ 25 mg/g in women. We compared the differences in least square means adjusted for age and sex, and adjusted for multiple traditional clinical covariates using a generalized linear model. Results: There were 834 participants in the study population (mean age 58.5 years, 61% women); 87 (10.4%) participants with CKD and 108 (13.0%) with microalbuminuria. In age and sex adjusted samples, we found that both BPA and F-RHI were significantly associated with CKD in the pooled samples. However in multivariable adjusted analysis the relation was no longer significant in either the pooled or sex-specific samples. In the multivariable adusted analysis,BPA was significantly (P=0.036) associated with microalbuminuria in men and F-RHI was weakly significantly (P=0.08) associated with microalbuminuria in women. Conclusion: We found that endothelial dysfunction as measured by digital arterial tonometry is not significantly associated with chronic kidney disease. There is an association of endothelial tone in men and endothelial dysfunction in women with microalbuminuria.