Non-Invasive Identification of Left Ventricular Hypertrophy and Cardiomegaly in Firefighters
U.S. Department of Homeland Security Award Number EMW-2011-FP-00663
P.I. Stefanos N. Kales MD, MPH, FACP, FACOEM; Harvard School of Public Health
Our study will analyze data from a cohort of firefighters to 1) determine the prevalence of left ventricular hypertrophy (LVH) and cardiomegaly among firefighters; 2) quantify major risk factors for LVH and cardiomegaly; 3) develop prediction models and/or screening algorithms; and 4) validate the models and/or screening algorithms. We will use a transthoracic cardiac echo, or ECHO, and an abbreviated cardiac MRI (CMR) to assess left ventricle, right ventricle, and overall heart mass; mass indices; and left atrium and and right atrium volumes. Our goal is to develop and validate cost effective methods for identifying LVH and cardiomegaly, which will enable clinical interventions to decrease firefighters’ morbidity and mortality.
Indianapolis Fire Department (IFD) members eligible for study randomization will include those with a) a recorded fire department exam in the last two years which included a maximal exercise tolerance test; b) males, 18 years of age or older; c) full duty status (no restrictions on duty) at the time of the randomization; and d) no contraindication to CMR.
Cardiovascular disease (CVD) is the leading cause of on-duty death in US firefighters and an important and costly cause of morbidity. LVH and cardiomegaly increase the risk of arrhythmia, myocardial infarction, and stroke and are proven predictors of higher mortality, but they have not been adequately researched in the fire service. Published studies and preliminary data in US firefighters demonstrate consistently that the majority of CVD death victims suffered from LVH and/or cardiomegaly, which is usually unrecognized before death. The literature supports that LVH and cardiomegaly are likely to be common in firefighters based on existing data and studies of LVH risk factors. If recognized, effective treatment measures are available. By combining the use of CMR with ECHO along with other comprehensive clinical data, we can most accurately estimate the prevalence of LVH and cardiomegaly in career firefighters, while developing accurate and cost-effective screening algorithms.