Blood metal concentrations and cardiac structure and function in total joint arthroplasty patients

Table 3 Association of metal concentrations with echocardiographic parameters

	Measure available	Mean (SD); Median (interquartile range)	Regression estimates (95%CI)1
Measure (unit)			Chromium	Cobalt	Titanium
LV size and systolic function
2D Biplane LV end-diastolic volume (mL)	100	134.04 (34.14); 129.5 (109, 153)	1.20 (-5.23 to 7.64)	5.09 (0.02-10.17)a	-3.67 (-8.55 to 1.22)
3D LV end-diastolic volume (mL)	95	130.38 (32.14); 126 (110, 147)	0.95 (-4.59 to 6.50)	4.09 (-0.57 to 8.74)a	-1.69 (-6.35 to 2.96)
2D Biplane LV end-systolic volume (mL)	99	50.76 (18.22); 48 (38, 60)	0.44 (-3.05 to 3.92)	3.13 (0.40-5.87)	-1.53 (-4.20 to 1.14)
3D LV end-systolic volume (mL)	94	49.24 (14.2); 48 (38, 57)	0.44 (-1.86 to 2.75)	1.46 (-0.50 to 3.42)	-1.16 (-3.09 to 0.76)
3D LV ejection fraction	94	62.12 (4.34); 62 (60, 65)	-0.10 (-0.88 to 0.68)	-0.51 (-1.17 to 0.15)	0.07 (-0.59 to 0.73)
LV global longitudinal strain	108	-19.74 (2.12); -20 (-21, -19)	-0.15 (-0.55 to 0.26)	-0.27 (-0.60 to 0.07)	-0.38 (-0.70 to 0.06)b
LV stroke volume (mL)	108	94.5 (17.22)/91 (82.5, 105)	-0.28 (-3.43 to 2.87)	1.59 (-0.99 to 4.16)	-2.69 (-5.24 to 0.15)b
LV cardiac output (l/minute)	109	6.12 (1.3); 5.84 (5.22, 6.8)	-0.01 (-0.35 to 0.16)	0.01 (-0.20 to 0.22)	-0.20 (-0.40 to 0.004)a
LV cardiac index (l/minute/m2)	108	2.92 (0.4)/2.82 (2.68,3.16)	0.01 (-0.08 to 0.09)	0.01 (-0.06 to 0.07)	-0.08 (-0.15 to -0.01)b
LV diastolic function
LV diastolic function (normal/abnormal)	110	Normal 42 (38.2)	Reference	Reference	Reference
		Abnormal 68 (61.8)	1.21 (0.78-1.87)	1.14 (0.80-1.62)	0.67 (0.47-0.97)b
Medial E/e' ratio	106	10.76 (3.7)/10 (8.3,12.5)	-0.38 (-1.02 to 0.27)	-0.05 (-0.60 to 0.49)	0.18 (-0.34 to 0.70)
LA biplane vol index (mL/m2)	107	31.32 (9.02); 30 (25, 37)	1.26 (-1.36 to 3.86)	2.72 (0.60-4.84)b	-0.24 ( -2.3 to 1.82)
LA reservoir strain	105	29.9 (6.9); 29.5 (26.2, 33.9)	0.002 (-1.38 to 1.39)	0.083 (-1.06 to 1.22)	1.602 (0.55-2.66)c
Right heart parameters
RV systolic pressure (mmHg)	80	28.34 (5.34); 28 (23.5, 32)	-0.41 (-1.54 to 0.73)	-0.22 (-1.19 to 0.75)	-0.28 (-1.15 to 0.58)
RV size (normal/enlarged)	110	Normal 99 (90)	Reference	Reference	Reference
		Abnormal 11 (10)	1.66 (0.91-3.05)	1.80 (1.08-2.99)b	1.22 (0.74-2.01)
RV basal diameter (mm)	53	40.48 (6.3); 41 (36, 46)	0.37 (-1.18 to 1.92)	1.17 (-0.18 to 2.51)a	-0.17 (-1.42 to 1.08)
Tricuspid annular plane systolic excursion (mm)	91	23.58 (3.7); 23 (21, 26)	-0.34 (-1.21 to 0.53)	0.11 (-0.61 to 0.83)	0.17 (-0.50 to 0.84)
RV Basal Lateral Systolic Strain	34	-25.06 (4.88); -26 (-29, -24)	1.19 (-0.64 to 3.01)	0.40 (-1.50 to 2.29)	-0.59 (-2.12 to 0.94)
Other parameters
Mid ascending thoracic aortic diameter (mm)	82	35.9 (4.08); 36 (33, 38)	0.16 (-0.65 to 0.98)	0.43 (-0.27 to 1.13)	-0.71 (-1.38 to -0.05)b
N terminal pro b-type natriuretic peptide (pg/mL)	109	153.4 (269.3); 85 (42, 138)	-20.47 (-72.32 to 31.38)	10.01 (-32.78 to 52.80)	13.41 (-27.74 to 54.55)
Troponin (ng/mL)	108	13.4 (11.3); 11 (7, 15)	-0.97 (-2.94 to 0.99)	-0.85 (-2.47 to 0.77)	0.22 (-1.34 to 1.78)

¹Estimates from age and sex-adjusted linear regression models indicate the β coefficients as the mean change in echocardiographic measures or cardiac markers per log-unit increase in metal concentrations. Odds ratio estimates from age and sex-adjusted logistic regression models indicate the odds of abnormal findings per log-unit increase in metal concentrations.

^a0.05 ≤ P < 0.1;

^b0.01 ≤ P < 0.05;

^cP < 0.01. LA: left atrium; LV: Left ventricular; RV: right ventricle.