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Associations of Left Ventricular Hypertrophy and Geometry with Adverse Outcomes in Patients with CKD and Hypertension.
Clin J Am Soc Nephrol. 2016 Feb 05; 11(2):271-9.CJ

Abstract

BACKGROUND AND OBJECTIVES

Left ventricular hypertrophy (LVH) and abnormal left ventricular (LV) geometry predict adverse outcomes in the general and hypertensive populations, but findings in CKD are still inconclusive.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

We enrolled 445 patients with hypertension and CKD stages 2-5 in two academic nephrology clinics in 1999-2003 who underwent both echocardiography and ambulatory BP monitoring. LVH (LV mass >100 g/m(2) [women] and >131 g/m(2) [men]) and relative wall thickness (RWT) were used to define LV geometry: no LVH and RWT≤0.45 (normal), no LVH and RWT>0.45 (remodeling), LVH and RWT≤0.45 (eccentric), and LVH and RWT>0.45 (concentric). We evaluated the prognostic role of LVH and LV geometry on cardiovascular (CV; composite of fatal and nonfatal events) and renal outcomes (composite of ESRD and all-cause death).

RESULTS

Age was 64.1±13.8 years old; 19% had diabetes, and 22% had CV disease. eGFR was 39.9±20.2 ml/min per 1.73 m(2). LVH was detected in 249 patients (56.0%); of these, 125 had concentric LVH, and 124 had eccentric pattern, whereas 71 patients had concentric remodeling. Age, women, anemia, and nocturnal hypertension were independently associated with both concentric and eccentric LVH, whereas diabetes and history of CV disease associated with eccentric LVH only, and CKD stages 4 and 5 associated with concentric LVH only. During follow-up (median, 5.9 years; range, 0.04-15.3), 188 renal deaths (112 ESRD) and 103 CV events (61 fatal) occurred. Using multivariable Cox analysis, concentric and eccentric LVH was associated with higher risk of CV outcomes (hazard ratio [HR], 2.59; 95% confidence interval [95% CI], 1.39 to 4.84 and HR, 2.79; 95% CI, 1.47 to 5.26, respectively). Similarly, greater risk of renal end point was detected in concentric (HR, 2.33; 95% CI, 1.44 to 3.80) and eccentric (HR, 2.30; 95% CI, 1.42 to 3.74) LVH. Sensitivity analysis using LVH and RWT separately showed that LVH but not RWT was associated with higher cardiorenal risk.

CONCLUSIONS

In patients with CKD, LVH is a strong predictor of the risk of poor CV and renal outcomes independent from LV geometry.

Links

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Authors+Show Affiliations

Paoletti E
Division of Nephrology, Dialysis and Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) University Hospital San Martino-Istituto Nazionale per la Ricerca sul Cancro (IST), University of Genoa, Genoa, Italy;
De Nicola L
Division of Nephrology and.
Gabbai FB
Department of Medicine, Veterans Affairs San Diego Healthcare System and University of California at San Diego Medical School, San Diego, California;
Chiodini P
Department of Medicine and Public Health, Second University of Naples, Naples, Italy;
Ravera M
Division of Nephrology, Dialysis and Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) University Hospital San Martino-Istituto Nazionale per la Ricerca sul Cancro (IST), University of Genoa, Genoa, Italy;
Pieracci L
Division of Nephrology, Dialysis and Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) University Hospital San Martino-Istituto Nazionale per la Ricerca sul Cancro (IST), University of Genoa, Genoa, Italy;
Marre S
Division of Nephrology, Dialysis and Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) University Hospital San Martino-Istituto Nazionale per la Ricerca sul Cancro (IST), University of Genoa, Genoa, Italy;
Cassottana P
Division of Cardiology, IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genoa, Italy;
Lucà S
Division of Cardiology, Santa Maria del Popolo degli Incurabili Hospital (PO SMdP Incurabili), Local Healthcare Unit Napoli1 Centro, Naples, Italy; and.
Vettoretti S
Unit of Nephrology-Dialysis, Urology and Renal Transplantation, Fondazione IRCCS Ca' Grande Ospedale Maggiore Policlinico, Milan, Italy.
Borrelli S
Division of Nephrology and.
Conte G
Division of Nephrology and.
Minutolo R
Division of Nephrology and roberto.minutolo@unina2.it.

MeSH

AdultAgedBlood PressureBlood Pressure Monitoring, AmbulatoryChi-Square DistributionDisease ProgressionEchocardiographyFemaleGlomerular Filtration RateHumansHypertensionHypertrophy, Left VentricularItalyKidneyKidney Failure, ChronicLogistic ModelsMaleMiddle AgedMultivariate AnalysisOdds RatioPredictive Value of TestsPrevalenceProportional Hazards ModelsProspective StudiesRenal Insufficiency, ChronicRisk AssessmentRisk FactorsTime FactorsVentricular Remodeling

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

26668021

Citation

Paoletti, Ernesto, et al. "Associations of Left Ventricular Hypertrophy and Geometry With Adverse Outcomes in Patients With CKD and Hypertension." Clinical Journal of the American Society of Nephrology : CJASN, vol. 11, no. 2, 2016, pp. 271-9.
Paoletti E, De Nicola L, Gabbai FB, et al. Associations of Left Ventricular Hypertrophy and Geometry with Adverse Outcomes in Patients with CKD and Hypertension. Clin J Am Soc Nephrol. 2016;11(2):271-9.
Paoletti, E., De Nicola, L., Gabbai, F. B., Chiodini, P., Ravera, M., Pieracci, L., Marre, S., Cassottana, P., Lucà, S., Vettoretti, S., Borrelli, S., Conte, G., & Minutolo, R. (2016). Associations of Left Ventricular Hypertrophy and Geometry with Adverse Outcomes in Patients with CKD and Hypertension. Clinical Journal of the American Society of Nephrology : CJASN, 11(2), 271-9. https://doi.org/10.2215/CJN.06980615
Paoletti E, et al. Associations of Left Ventricular Hypertrophy and Geometry With Adverse Outcomes in Patients With CKD and Hypertension. Clin J Am Soc Nephrol. 2016 Feb 5;11(2):271-9. PubMed PMID: 26668021.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Associations of Left Ventricular Hypertrophy and Geometry with Adverse Outcomes in Patients with CKD and Hypertension. AU - Paoletti,Ernesto, AU - De Nicola,Luca, AU - Gabbai,Francis B, AU - Chiodini,Paolo, AU - Ravera,Maura, AU - Pieracci,Laura, AU - Marre,Sonia, AU - Cassottana,Paolo, AU - Lucà,Sergio, AU - Vettoretti,Simone, AU - Borrelli,Silvio, AU - Conte,Giuseppe, AU - Minutolo,Roberto, Y1 - 2015/12/14/ PY - 2015/06/26/received PY - 2015/10/30/accepted PY - 2015/12/16/entrez PY - 2015/12/17/pubmed PY - 2017/1/11/medline KW - blood pressure monitoring, ambulatory KW - chronic kidney disease KW - echocardiography KW - female KW - follow-up studies KW - humans KW - hypertension KW - hypertrophy, left ventricular KW - left ventricular geometry SP - 271 EP - 9 JF - Clinical journal of the American Society of Nephrology : CJASN JO - Clin J Am Soc Nephrol VL - 11 IS - 2 N2 - BACKGROUND AND OBJECTIVES: Left ventricular hypertrophy (LVH) and abnormal left ventricular (LV) geometry predict adverse outcomes in the general and hypertensive populations, but findings in CKD are still inconclusive. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We enrolled 445 patients with hypertension and CKD stages 2-5 in two academic nephrology clinics in 1999-2003 who underwent both echocardiography and ambulatory BP monitoring. LVH (LV mass >100 g/m(2) [women] and >131 g/m(2) [men]) and relative wall thickness (RWT) were used to define LV geometry: no LVH and RWT≤0.45 (normal), no LVH and RWT>0.45 (remodeling), LVH and RWT≤0.45 (eccentric), and LVH and RWT>0.45 (concentric). We evaluated the prognostic role of LVH and LV geometry on cardiovascular (CV; composite of fatal and nonfatal events) and renal outcomes (composite of ESRD and all-cause death). RESULTS: Age was 64.1±13.8 years old; 19% had diabetes, and 22% had CV disease. eGFR was 39.9±20.2 ml/min per 1.73 m(2). LVH was detected in 249 patients (56.0%); of these, 125 had concentric LVH, and 124 had eccentric pattern, whereas 71 patients had concentric remodeling. Age, women, anemia, and nocturnal hypertension were independently associated with both concentric and eccentric LVH, whereas diabetes and history of CV disease associated with eccentric LVH only, and CKD stages 4 and 5 associated with concentric LVH only. During follow-up (median, 5.9 years; range, 0.04-15.3), 188 renal deaths (112 ESRD) and 103 CV events (61 fatal) occurred. Using multivariable Cox analysis, concentric and eccentric LVH was associated with higher risk of CV outcomes (hazard ratio [HR], 2.59; 95% confidence interval [95% CI], 1.39 to 4.84 and HR, 2.79; 95% CI, 1.47 to 5.26, respectively). Similarly, greater risk of renal end point was detected in concentric (HR, 2.33; 95% CI, 1.44 to 3.80) and eccentric (HR, 2.30; 95% CI, 1.42 to 3.74) LVH. Sensitivity analysis using LVH and RWT separately showed that LVH but not RWT was associated with higher cardiorenal risk. CONCLUSIONS: In patients with CKD, LVH is a strong predictor of the risk of poor CV and renal outcomes independent from LV geometry. SN - 1555-905X UR - https://www.unboundmedicine.com/medline/citation/26668021/Associations_of_Left_Ventricular_Hypertrophy_and_Geometry_with_Adverse_Outcomes_in_Patients_with_CKD_and_Hypertension_ DB - PRIME DP - Unbound Medicine ER -