Research articles: Heart failureElevated serum osteoprotegerin is associated with increased left ventricular mass index and myocardial stiffnessKamimura, Daisukea; Suzuki, Takekia; Furniss, Anna L.b; Griswold, Michael E.b; Kullo, Iftikhar J.c; Lindsey, Merry L.d,e; Winniford, Michael D.a; Butler, Kenneth R.f; Mosley, Thomas H.f; Hall, Michael E.a,dAuthor Information aDivision of Cardiology bDepartment of Medicine, Center for Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, Mississippi cDivision of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota dDepartment of Physiology and Biophysics, Mississippi Center for Heart Research, University of Mississippi Medical Center eResearch Service, G.V. (Sonny) Montgomery Veterans Affairs Medical Center fDivision of Geriatric Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA Correspondence to Daisuke Kamimura, Department of Medicine-Cardiology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA Tel: +1 601 984 4607; fax: +1 601 984 5608; e-mail: [email protected] Received 19 May, 2017 Revised 12 July, 2017 Accepted 22 July, 2017 Journal of Cardiovascular Medicine: December 2017 - Volume 18 - Issue 12 - p 954-961 doi: 10.2459/JCM.0000000000000549 Buy Metrics Abstract Aim Osteoprotegerin (OPG) is associated with a poor prognosis in patients with heart failure with preserved ejection fraction (HFpEF). OPG has also been associated with fibrosis and collagen cross-linking, which increase arterial and left ventricle (LV) myocardial stiffness. Little is known about the relation of OPG and LV structure and function in African-Americans who are disproportionately affected by HFpEF. Methods and results Our analysis included 1172 participants with preserved LV ejection fraction (>50%) from the African-American cohort in the Genetic Epidemiology Network of Arteriopathy Study (mean age 63 years, 72% female). We used diastolic wall strain indicator measured by echocardiography to assess LV myocardial stiffness. Diastolic wall strain was calculated as (LV posterior thickness at end-systole − LV posterior thickness at end-diastole)/LV posterior thickness at end-systole. Associations between OPG levels and indices of arterial and LV structure and function were evaluated by using generalized linear mixed models and adjusted for possible confounders. OPG levels were correlated with age, female sex, presence of hypertension and diabetes, and lower estimated glomerular filtration rate (P < 0.05 for all). Multivariable analysis revealed that higher OPG levels were associated with greater LV mass index, increased LV myocardial stiffness, and higher N-terminal prohormone brain natriuretic peptide levels (P < 0.05 for all). Conclusion In African-Americans, higher OPG levels were associated with characteristics common in patients with HFpEF and were significantly associated with known precursors to HFpEF. These findings indicate a potential role for OPG in the pathophysiology of HFpEF in African-Americans. © 2017 Italian Federation of Cardiology. All rights reserved.