Echocardiography protocol and cardiometabolic phenotyping in Indian birth cohorts—the IndEcho study

Background Asian Indians are at higher risk of cardiometabolic disease compared to other ethnic groups, and the age of onset is typically younger. Cardiac structure and function are poorly characterized in this ethnic group. In this study, we describe image-acquisition methods and the reproducibility of measurements and detailed echocardiography characteristics in two large Indian population-based cohorts (the New Delhi and Vellore Birth Cohorts) from India. Methods The IndEcho study captured transthoracic echocardiographic measurements of cardiac structure and function from 2,322 men and women aged 43–50 years. M-mode measurements in the parasternal long axis (PLAX) and 2-dimensional (2D) short axis recordings at the mitral valve, mid-papillary and apical level were recorded. Apical 2D recordings of two- three- and four-chamber (2C, 3C and 4C) views and Doppler images (colour, pulsed and continuous) were recorded in cine-loop format. Left ventricular (LV) mass, LV hypertrophy, and indices of LV systolic and diastolic function were derived. Results Echocardiographic measurements showed good/excellent technical reproducibility. Hetero-geneity across sites, sex and rural/urban differences in cardiac structure and function were observed. Overall, this cohort of South Asian Indians had smaller LV mass and normal systolic and diastolic function when compared with published data on other Asian Indians and the West, (LV mass indexed for body surface area: Delhi men: 68 g/m2, women 63.9; Vellore men: 65.8, women 61.6) but were within ethnic-specific reference ranges. The higher prevalence of obesity, diabetes and hypertension is reflected by the higher proportion of LV remodelling and lesser hypertrophy. Conclusions Our study adds to scarce population-based echocardiographic data for mid-life Asian Indians. Compared to published literature on other ethnic groups, the Asian Indian heart is characterised by smaller cardiac dimensions and normal range systolic and diastolic function on a background of a high prevalence of hypertension, diabetes and cardiac disease at a relatively young age. This data will form the basis for further analyses of lifecourse, metabolic and body composition predictors of cardiac structure and function, and echocardiographic predictors of future mortality. ISRCTN registration number 13432279

[1]  D. Khanra,et al.  A study on normal reference values of echocardiographic chamber dimensions in young eastern Indian adults , 2020, Indian heart journal.

[2]  S. Sengupta,et al.  Normative values of cardiac chamber dimensions and global longitudinal strain in Indians: the Indian Normative Data of Echocardiography Analyzed (INDEA) study , 2020, The International Journal of Cardiovascular Imaging.

[3]  J. Kirkpatrick,et al.  Similarities and Differences in Left Ventricular Size and Function among Races and Nationalities: Results of the World Alliance Societies of Echocardiography Normal Values Study. , 2019, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[4]  J. Mariani,et al.  Sex Differences in Heart Failure With Preserved Ejection Fraction Pathophysiology: A Detailed Invasive Hemodynamic and Echocardiographic Analysis. , 2019, JACC. Heart failure.

[5]  Stephen S. Lim,et al.  The changing patterns of cardiovascular diseases and their risk factors in the states of India: the Global Burden of Disease Study 1990–2016 , 2018, The Lancet. Global health.

[6]  Deepika Jain,et al.  Global longitudinal strain, ejection fraction, effort tolerance and normal echocardiography measurements in healthy Indians , 2018, Indian heart journal.

[7]  D. Prabhakaran,et al.  IndEcho study: cohort study investigating birth size, childhood growth and young adult cardiovascular risk factors as predictors of midlife myocardial structure and function in South Asians , 2018, BMJ Open.

[8]  A. Bhambhani,et al.  Real-time three-dimensional echocardiographic left heart parameters in healthy indian adults , 2017, Indian heart journal.

[9]  D. Prabhakaran,et al.  Cardiovascular, Respiratory, and Related Disorders: Key Messages and Essential Interventions to Address Their Burden in Low- and Middle-Income Countries , 2017 .

[10]  S. Underwood,et al.  Systematic review of cost-effectiveness of myocardial perfusion scintigraphy in patients with ischaemic heart disease: A report from the cardiovascular committee of the European Association of Nuclear Medicine. Endorsed by the European Association of Cardiovascular Imaging. , 2017, European heart journal cardiovascular Imaging.

[11]  Terry K Koo,et al.  A Guideline of Selecting and Reporting Intraclass Correlation Coefficients for Reliability Research. , 2016, Journal of chiropractic medicine.

[12]  D. Prabhakaran,et al.  Cardiovascular Diseases in India: Current Epidemiology and Future Directions , 2016, Circulation.

[13]  S. Sengupta,et al.  Normal echocardiographic measurements in Indian adults: How different are we from the western populations? A pilot study , 2016, Indian heart journal.

[14]  F. Flachskampf,et al.  Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. , 2016, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[15]  Andrew E Moran,et al.  Global and Regional Patterns in Cardiovascular Mortality From 1990 to 2013 , 2015, Circulation.

[16]  N. Freemantle,et al.  Ethnic-Specific Normative Reference Values for Echocardiographic LA and LV Size, LV Mass, and Systolic Function: The EchoNoRMAL Study. , 2015, JACC. Cardiovascular imaging.

[17]  A. Barros,et al.  Local Distributions of Wealth to Describe Health Inequalities in India: A New Approach for Analyzing Nationally Representative Household Survey Data, 1992–2008 , 2014, PloS one.

[18]  Arjun K. Ghosh,et al.  Left-Ventricular Structure in the Southall And Brent REvisited (SABRE) Study: Explaining Ethnic Differences , 2013, Hypertension.

[19]  J. Kooner,et al.  Population-based reference values for 3D echocardiographic LV volumes and ejection fraction. , 2012, JACC. Cardiovascular imaging.

[20]  Mark D. Huffman,et al.  Incidence of cardiovascular risk factors in an Indian urban cohort results from the New Delhi birth cohort. , 2011, Journal of the American College of Cardiology.

[21]  J. Kooner,et al.  Ethnicity-related differences in left ventricular function, structure and geometry: a population study of UK Indian Asian and European white subjects , 2009, Heart.

[22]  C. Fall,et al.  Cohort Profile: the 1969-73 Vellore birth cohort study in South India. , 2009, International journal of epidemiology.

[23]  F. Flachskampf,et al.  Recommendations for the evaluation of left ventricular diastolic function by echocardiography. , 2009, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[24]  S. Yusuf,et al.  Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study , 2004, The Lancet.

[25]  Clive Osmond,et al.  Relation of serial changes in childhood body-mass index to impaired glucose tolerance in young adulthood. , 2004, The New England journal of medicine.

[26]  J. Shaw,et al.  Follow-up report on the diagnosis of diabetes mellitus. , 2003, Diabetes care.

[27]  P. Okin,et al.  Prognostic implications of left ventricular hypertrophy. , 2001, American heart journal.

[28]  H. Schunkert,et al.  Gender specific differences in left ventricular adaptation to obesity and hypertension , 1998, Journal of Human Hypertension.

[29]  H. S. Klopfenstein,et al.  Sex, age, and disease affect echocardiographic left ventricular mass and systolic function in the free-living elderly. The Cardiovascular Health Study. , 1995, Circulation.

[30]  J. Voigt,et al.  Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. , 2015, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.