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Defining left ventricular remodeling using lean body mass allometry: a UK Biobank study

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European Journal of Applied Physiology Aims and scope Submit manuscript

Abstract

Purpose

The geometric patterns of ventricular remodeling are determined using indexed left ventricular mass (LVM), end-diastolic volume (LVEDV) and concentricity, most often measured using the mass-to-volume ratio (MVR). The aims of this study were to validate lean body mass (LBM)-based allometric coefficients for scaling and to determine an index of concentricity that is independent of both volume and LBM.

Methods

Participants from the UK Biobank who underwent both CMR and dual-energy X-ray absorptiometry (DXA) during 2014–2015 were considered (n = 5064). We excluded participants aged ≥ 70 years or those with cardiometabolic risk factors. We determined allometric coefficients for scaling using linear regression of the logarithmically transformed ventricular remodeling parameters. We further defined a multiplicative allometric relationship for LV concentricity (LVC) adjusting for both LVEDV and LBM.

Results

A total of 1638 individuals (1057 female) were included. In subjects with lower body fat percentage (< 25% in males, < 35% in females, n = 644), the LBM allometric coefficients for scaling LVM and LVEDV were 0.85 ± 0.06 and 0.85 ± 0.03 respectively (R2 = 0.61 and 0.57, P < 0.001), with no evidence of sex–allometry interaction. While the MVR was independent of LBM, it demonstrated a negative association with LVEDV in (females: r = − 0.44, P < 0.001; males: − 0.38, P < 0.001). In contrast, LVC was independent of both LVEDV and LBM [LVC = LVM/(LVEDV0.40 × LBM0.50)] leading to increased overlap between LV hypertrophy and higher concentricity.

Conclusions

We validated allometric coefficients for LBM-based scaling for CMR indexed parameters relevant for classifying geometric patterns of ventricular remodeling.

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Data availability statement

All data in this study are available from UK Biobank (http://www.ukbiobank.ac.uk/). The authors confirm that they had full access to the data and that they take full responsibility for its integrity. All data are available on request to the UK Biobank.

Abbreviations

BMI:

Body mass index

BP:

Blood pressure

BSA:

Body surface area

CMR:

Cardiac magnetic resonance

CO:

Cardiac output

DXA:

Dual-energy X-ray absorptiometry

MESA:

Multiethnic study of atherosclerosis

MVR:

Mass-to-volume ratio

LAV:

Left atrial volume

LBM:

Lean body mass

LVC:

Left ventricular concentricity, by multiplicative allometry

LVE:

Left ventricular enlargement

LVEF:

Left ventricular ejection fraction

LVEDV:

Left ventricular end-diastolic volume

LVESV:

Left ventricular end-systolic volume

LVH:

Left ventricular hypertrophy

LVM:

Left ventricular mass

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Acknowledgements

We would like to acknowledge the UK Biobank and the support of Stanford Cardiovascular Institute and the German Research Foundation.

Funding

This research was made possible by an institutional research grant from Stanford Cardiovascular Institute. BG received funding from the Deutsche Forschungsgemeinschaft (DFG—German Research Foundation) under the Walter-Benjamin Program (GO 3196/3-1, 707766-809341).

Author information

Author notes

  1. Bruna Gomes and Kristofer Hedman equally contributed to the manuscript.

  2. Bruna Gomes and Francois Haddad equally mentored the project and are equivalent senior authors.

Authors and Affiliations

  1. Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, 94304, USA

    Bruna Gomes, Kristofer Hedman, David Hsu, Yukari Kobayashi, Erik Ingelsson, Michael Salerno, Euan Ashley & Francois Haddad

  2. Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA

    Bruna Gomes, Kristofer Hedman, Yukari Kobayashi, Michael Salerno, Euan Ashley & Francois Haddad

  3. Department of Cardiology, Pneumology and Angiology, Heidelberg University Hospital, Heidelberg, Germany

    Bruna Gomes

  4. Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium

    Tatiana Kuznetsova & Nicholas Cauwenberghs

  5. Research Institute for Sports and Exercise Sciences, Liverpool John Moores University, Liverpool, L3 9UT, UK

    David Oxborough & Keith George

  6. Department of Clinical Physiology in Linköping, Linköping University, Linköping, Sweden

    Kristofer Hedman

  7. Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden

    Kristofer Hedman

  8. Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94304, USA

    Bruna Gomes

  9. Stanford University School of Medicine, Falk Building 870 Quarry Rd, Stanford, CA, 94304, USA

    Francois Haddad

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  1. Bruna Gomes
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Contributions

FH, BG and KH conceived and designed the research. KG provided great methodological insight for the analysis. KH and DH prepared the dataset. FH and BG analyzed the data. FH wrote the manuscript with BG, and editorial feedback and review was done by all the authors. All authors read and approved the manuscript.

Corresponding authors

Correspondence to Bruna Gomes or Francois Haddad.

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Conflict of interest

The authors acknowledge the institutional research grants by Verily Inc. FH received institutional research grant from Actelion Inc. within the last 2 years as well as an institutional research grant from Precordior Inc.

Additional information

Communicated by Ellen Adele Dawson.

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Supplementary Information

Below is the link to the electronic supplementary material.

421_2022_5125_MOESM1_ESM.pdf

Supplemental Figure 1. Relationship between metrics of body size. Panel A. Metrics of body size are not independent of each other with strong association between LBM, height and BSA. Panel B. LBM relates to height allometrically with an allometric coefficient of 1.9 in both male and female (no residual body size dependence and an R2 =0.81, P<0.001). Panel C and D shows the relationship between LBM increase in obesity highlighting a small increase in scaled LBM with greater fat percentage

421_2022_5125_MOESM2_ESM.pdf

Supplemental Figure 2. Body size independence of scaling metrics. Panel A and B highlight body size independence of LVM scaling to LBM in female and male. Panel C and D: when scaling to height to an allometric coefficient of 1.7 only a weak relationship in female with reference body fat percentage was noted

421_2022_5125_MOESM3_ESM.pdf

Supplemental Figure 3. Concentricity and pattern of geometric remodeling. Panel A and B shows the pattern of geometric remodeling patterns in male subjects

421_2022_5125_MOESM4_ESM.pdf

Supplemental Figure 4. LV concentricity based on end-diastolic volume and height. Panel A and B. Body size independence of LV concentricity in both female and male. Panel C and D shows the Patterns of geometrical remodeling based on LV concentricity (LVEDV and height) versus MVR

Supplementary Tables 1 and 2 (DOCX 13 KB)

Supplementary Table 3 (DOCX 14 KB)

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Gomes, B., Hedman, K., Kuznetsova, T. et al. Defining left ventricular remodeling using lean body mass allometry: a UK Biobank study. Eur J Appl Physiol 123, 989–1001 (2023). https://doi.org/10.1007/s00421-022-05125-9

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