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Predictors of diastolic dysfunction in ethnic groups: observations from the Hypertensive Cohort of The Ethnic-Echocardiographic Heart of England Screening Study (E-ECHOES)

Journal of Human Hypertension volume 32, pages 477–486 (2018)Cite this article

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Abstract

The study aimed to establish a relationship of ethnicity to diastolic dysfunction in subjects of African-Caribbean and South Asian origins and the impact of diastolic dysfunction and ethnicity on all-cause and cardiovascular mortality. Hypertensive subjects with ejection fraction ≥55% and no history of ischaemic heart disease/valve pathology (n  =  1546, 830 South Asians and 716 African-Caribbeans) were identified from the Ethnic-Echocardiographic Heart of England Screening Study (E-ECHOES). Diastolic function and cardiac remodelling were measured by echocardiography. African-Caribbean ethnicity was associated with lower prevalence of having diastolic dysfunction (odds ratio 0.67, 95% confidence interval 0.51–0.87, p  =  0.003) and increased left ventricular filling pressure (odds ratio 0.48, 95% confidence interval 0.34–0.69, p <  0.001) as well as lower left atrial index (p  <  0.001). This was the case despite the fact that African-Caribbean ethnicity was independently associated with higher left ventricular mass index (p   < 0.001). Ninety-two deaths (6%) occurred during 68  ±  21 months follow-up. On Cox regression analysis, South Asian ethnicity (p  =  0.024) was predictive of all-cause death before adjustment for parameters of diastolic dysfunction, but it was no longer predictive of death after accounting for these variables. South Asian ethnicity is independently associated with worse parameters of diastolic function in hypertension, despite African-Caribbeans having more prominent hypertrophy.

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Acknowledgements

We are grateful to all the subjects, practice staff including receptionists, nurses, managers, and general practitioners for taking part in this study. We are grateful to Dr. Mikhail Dzeshka for coding of diastolic function. General Practice Centres: Rotton Park Medical Centre, City Road Medical Practice, Cavendish Medical Practice, Ann Jones Family Health Centre, Shanklin House Surgery, Burbury Street Surgery, Heathford Group Practice, Broadway Health Centre, Victoria Road Medical Centre, Churchill Medical Centre, St. Clements Surgery, Handsworth Medical Centre, Soho Health Centre, Church Road Surgery, Bloomsbury Health Centre, Al-Shafa Medical Practice, Enki Medical Practice, Aston Pride Health Centre, Newtown Health Centre, Hockley Medical Centre.

Funding

This work was supported by the British Heart Foundation (PG/05/036), Heart of Birmingham Teaching Primary Care Trust, and through the National Health Service R&D support funding (Primary Care Research Network—Central England). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Authors and Affiliations

  1. Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK

    Alena Shantsila, Eduard Shantsila & Gregory Y. H. Lip

  2. Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK

    Paramjit S. Gill

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  1. Alena Shantsila
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Correspondence to Gregory Y. H. Lip.

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These authors contributed equally: Paramjit S. Gill, Gregory Y. H. Lip.

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Shantsila, A., Shantsila, E., Gill, P.S. et al. Predictors of diastolic dysfunction in ethnic groups: observations from the Hypertensive Cohort of The Ethnic-Echocardiographic Heart of England Screening Study (E-ECHOES). J Hum Hypertens 32, 477–486 (2018). https://doi.org/10.1038/s41371-018-0064-z

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