Table 4.
Imaging studies of cardiac structure and function in South Asians compared with Europeans.
| First author | Study groups | Key inclusion/exclusion | Modality | Main findings | |
|---|---|---|---|---|---|
| South Asians | Europeans | ||||
| Chahal et al.110 |
n = 259, 47% F Age: 51 ± 9 years |
n = 199, 40% F Age: 52 ± 9 years |
Healthy subjects with no hypertension, dyslipidaemia, T2D, smoking or coronary disease. LOLIPOP cohort, UK | 2D echocardiography | ↓ left heart volumes and ↓ LV mass index in Indian Asians. |
| ↑ concentric remodelling in Indian Asians (relative wall thickness 0.37 versus 0.35, p < 0.001) independent of age, sex, BP, and BMI. | |||||
| ↓ LV function in Indian Asians, demonstrated by ↓ s’ (8.9 ± 1.5 cm/s versus 9.5 ± 1.6 cm/s), ↓ e’, (10.3 ± 2.1 cm/s versus 11.0 ± 2.1 cm/s) and ↑ E/e’ ratio (7.9 ± 2.1 versus 7.0 ± 1.5), all p < 0.001. | |||||
| Chahal et al.108 |
n = 1159, 33% F Age: 57 ± 10 years, 5–9% T2D |
n = 968, 26% F Age: 57 ± 10 years, 16–21% T2D |
General population with no clinical cardiovascular disease. LOLIPOP cohort, UK | 2D echocardiography | ↑ prevalence of LV hypertrophy in Indian Asian men (adjusted OR 2.8, 95% CI 1.9–4.2) but not in women (adjusted OR 1.1, 95% CI 0.6–2.2). |
| ↑ concentric remodelling in Indian Asians (adjusted RWT for men 0.41 versus 0.39, p < 0.001; women 0.40 versus 0.38, p < 0.01). | |||||
| ↓ longitudinal systolic function and diastolic function in Indian Asians (lower s’ and e’ and higher E/e’, all p < 0.05 Indian Asians versus Europeans). | |||||
| Park et al.111 |
n = 325, 12% F Age: 69 ± 7 years, 38% T2D |
n = 427, 22% F Age: 70 ± 6 years,15% T2D |
First generation migrant South Asian. SABRE cohort, UK | 3D echocardiography | ↓ LV mass in South Asians when indexed to height2.7 (28.1 ± 0.4 g/m2.7 versus 29.8 ± 0.3 g/m2.7) or body surface area (61.9 ± 0.7 g/m2 versus 66.1 ± 0.6 g/m2), all p < 0.01. Findings persisted after adjusting for cardiometabolic risk factors. |
| ↓ LV remodelling index (LV mass/volume) in South Asians (1.47 ± 0.02 versus 1.52 ± 0.02, p < 0.05) independent of cardiometabolic risk factors. | |||||
| Park et al.109 |
n = 457, 15% F Age: 69 ± 6 years, 41% T2D |
n = 542, 23% F Age: 70 ±6 years, 18% T2D |
First generation migrant South Asians. SABRE cohort, UK | 2D echocardiography | ↑ adverse effect of T2D on South Asians than Europeans with worse diastolic (E/e’ beta 0.69 ± 0.12 versus 0.09 ± 0.2, p for HbA1c/ethnicity interaction = 0.005) and systolic function (s’ beta −0.11 ± 0.06 versus 0.14 ± 0.09, p interaction = 0.2). |
| Multivariable adjustment for hypertension, microvascular disease, LV mass, coronary disease and dyslipidaemia only partially accounted for the ethnic differences. | |||||
| Paiman et al.112 | T2D: n = 33, 64% F Age: 51 ± 9 years Controls: n = 21, 71% F Age: 48 ± 8 years |
T2D: n = 48, 42% F Age: 60 ± 7 years Controls: n = 29, 48% F Age: 58 ±8 years |
Overweight T2D, no history of significant coronary or valvular disease, no NYHA III-IV heart failure | Cardiac MRI at three Tesla and proton-magnetic resonance spectroscopy | ↑ LV concentric remodelling and ↓ diastolic function (lower E/A ratio) and seen in both South Asians and Europeans with T2D. |
| In T2D versus controls South Asians: ↑ LV mass (93 ± 20 versus 66 ± 15 g), myocardial cell volume (66±16 versus 45 ± 11 ml), and extracellular volume (23 ± 5 versus 18 ± 4 ml) but ↓ extracellular volume fraction (26.2 ± 3.0 versus 28.2 ± 2.6%). All p < 0.05. | |||||
| In T2D versus controls Europeans: ↑ myocardial triglyceride (1.19 ± 0.53 versus 0.58 ± 0.18%) and impaired LV global longitudinal strain (−19.3 ± 2.7 versus −21.1 ± 3.3%). All p < 0.05. | |||||
A, transmitral peak late diastolic flow velocity; E, transmitral peak early diastolic flow velocity; e’, mitral annular early diastolic velocity; LOLIPOP, London Life Science Prospective Population; LV, left ventricle; MRI, magnetic resonance imaging; NYHA, New York Heart Association; SABRE, Southall and Brent Revisited study; s’, mitral annular systolic velocity; T2D, type 2 diabetes.