Left ventricular concentric remodeling is highly common among veterans previously deployed to Southwest Asia Theater of Military Operations and associated with impaired exercise performance.

Steven J Cassady, Post-Deployment Cardiopulmonary Evaluation Network, Thomas J Abitante, Gregory Pappas, Thomas Alexander, Michael Falvo
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Abstract

Background: Environmental factors, such as exposure to airborne hazards, contribute to cardiac remodeling through a variety of mechanisms including direct cardiotoxicity. Left ventricular concentric remodeling (LVCR) is a pathological process of adaptive myocardial change that may represent a precursor state for systolic and diastolic dysfunction and left ventricular hypertrophy. Given that potentially cardiotoxic airborne hazards, such as those produced by open burn pits, have been found to occur in excess in active military combat zones, deployed veterans may be at increased risk for adverse cardiac remodeling, but this has not been thoroughly investigated. Methods: 139 veterans of Southwest Asia Theater of Military Operations underwent transthoracic echocardiography, cardiopulmonary exercise testing (CPET), and health questionnaires. Two-dimensional echocardiography was used to quantify relative wall thickness (RWT) to classify left ventricular (LV) geometry as normal, concentric/eccentric hypertrophy, or LVCR. Observed rates of LVCR were compared to those reported in the Framingham Heart Study, and CPET results were compared between those with and without LVCR. We examined the association between RWT and select CPET outcomes via an adjusted multivariate regression model. Results: The prevalence of LVCR in the veteran sample (30.2%) was elevated compared to the Framingham Heart Study cohort (6-16%). Demographics and risk factors were similar between veterans with LVCR and normal geometry; however, veterans with LVCR had reduced exercise capacity (VO2, 23.7 vs 26.2 ml/kg/min, p<0.05), more inefficient exercise ventilation (VE/V?CO2 nadir: 26.8 vs 25.2, p<0.05), and increased heart rate (HR) reserve (24.7 vs 17.4, p<0.05). RWT was independently associated only with peak HR attained and HR reserve. Conclusions: In our sample of deployed veterans without significant risk factors, the observed rates of LVCR are 2- to 5-fold greater than those reported in a historical civilian cohort. Further, veterans with LVCR also had impaired exercise performance relative to those with normal LV geometry despite otherwise appearing similar. These findings underscore the importance of cardiovascular assessments as part of a dyspnea evaluation for deployed veterans with airborne hazards exposure and raise concerns about their long-term cardiovascular health.
左心室同心重塑在曾被部署到西南亚军事行动区的退伍军人中非常常见,并与运动表现受损有关。
背景:环境因素(如暴露于空气中的有害物质)通过各种机制(包括直接的心脏毒性)导致心脏重塑。左心室同心重塑(LVCR)是一种适应性心肌变化的病理过程,可能代表着收缩和舒张功能障碍以及左心室肥大的前驱状态。方法:139 名西南亚军事行动区的退伍军人接受了经胸超声心动图检查、心肺运动测试 (CPET) 和健康问卷调查。二维超声心动图用于量化相对壁厚(RWT),将左心室几何形状分为正常、同心/异心肥厚或左心室肥厚。我们将观察到的 LVCR 发生率与弗雷明汉心脏研究报告的发生率进行了比较,并对有 LVCR 和无 LVCR 的 CPET 结果进行了比较。结果:与弗雷明汉心脏研究队列(6-16%)相比,退伍军人样本(30.2%)的 LVCR 患病率较高。患有 LVCR 的退伍军人和正常几何形状的退伍军人的人口统计学和风险因素相似;但是,患有 LVCR 的退伍军人的运动能力降低(VO2,23.7 vs 26.2 ml/kg/min,p<0.05),运动通气效率更低(VE/V?CO2 nadir:26.8 vs 25.2,p<0.05),心率储备(HR)增加(24.7 vs 17.4,p<0.05)。RWT 仅与达到的峰值心率和心率储备独立相关。结论:在我们的无重大风险因素的已部署退伍军人样本中,观察到的 LVCR 发生率比历史平民队列中报告的发生率高 2 到 5 倍。此外,与左心室几何形状正常的退伍军人相比,患有左心室损伤的退伍军人的运动表现也受到了影响,尽管他们在其他方面看起来相似。这些发现强调了心血管评估作为呼吸困难评估的一部分对于暴露于空气传播危害的已部署退伍军人的重要性,并引起了人们对他们长期心血管健康的关注。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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