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Left ventricular mass index increase in early renal disease: impact of decline in hemoglobin
A Levin1, C R Thompson, J Ethier
1Centre for Health Outcomes and Evaluation Sciences, St Paul's Hospital, Vancouver, Canada. alevin@stpaulshosp.bc.ca
Insights
Left ventricular growth (LVG) in patients with kidney disease is linked to declining hemoglobin and rising blood pressure. Managing these factors may help prevent LVG and improve outcomes in this population.
Area of Science:
- Nephrology
- Cardiology
- Echocardiography
Background:
- Cardiovascular disease is prevalent in patients with progressive renal disease.
- Left ventricular hypertrophy (LVH) is a common and significant predictor of morbidity and mortality in dialysis patients.
- Factors influencing left ventricular growth (LVG) in mild-to-moderate renal insufficiency are not well understood.
Purpose of the Study:
- To identify factors associated with left ventricular growth (LVG) in patients with mild-to-moderate renal insufficiency.
- To investigate the relationship between modifiable risk factors and LVG.
- To inform potential therapeutic strategies for improving cardiovascular outcomes in renal insufficiency.
Main Methods:
- Prospective, multicenter Canadian cohort study.
- Enrolled 446 patients with progressive renal disease, with 246 having assessable echocardiograms at baseline and 12 months.
- Measured left ventricular mass index (LVMI) using two-dimensional-targeted M-mode echocardiography.
Main Results:
- Overall prevalence of LVH was 36% at baseline.
- LVMI increased significantly in 25% of the population over 12 months.
- Independent predictors of LVG included decreased hemoglobin levels (OR, 1.32 per 0.5-g/dL decrease) and increased systolic blood pressure (OR, 1.11 per 5-mm Hg increase), after adjusting for baseline LVMI.
Conclusions:
- Declining hemoglobin and increasing systolic blood pressure are independently associated with LVG in patients with mild-to-moderate renal insufficiency.
- These findings highlight important modifiable risk factors for LVG.
- There is a critical need for optimal therapeutic strategies to manage these factors and improve clinical outcomes.
Abstract:
Cardiovascular disease occurs in patients with progressive renal disease both before and after the initiation of dialysis. Left ventricular hypertrophy (LVH) is an independent predictor of morbidity and mortality in dialysis populations and is common in the renal insufficiency population. LVH is associated with numerous modifiable risk factors, but little is known about LV growth (LVG) in mild-to-moderate renal insufficiency. This prospective multicenter Canadian cohort study identifies factors associated with LVG, measured using two-dimensional-targeted M-mode echocardiography. Eight centers enrolled 446 patients, 318 of whom had protocol-mandated clinical, laboratory, and echocardiographic measurements recorded. We report 246 patients with assessable echocardiograms at both baseline and 12 months with an overall prevalence of LVH of 36%. LV mass index (LVMI) increased significantly (>20% of baseline or >20 g/m2) from baseline to 12 months in 25% of the population. Other than baseline LVMI, no differences in baseline variables were noted between patients with and without LVG. However, there were significant differences in decline of Hgb level (-0.854 v -0.108 g/dL; P = 0.0001) and change in systolic blood pressure (+6.50 v -1.09 mm Hg; P = 0.03) between the groups with and without LVG. Multivariate analysis showed the independent contribution of decrease in Hgb level (odds ratio [OR], 1.32 for each 0.5-g/dL decrease; P = 0.004), increase in systolic blood pressure (OR, 1.11 for each 5-mm Hg increase; P = 0.01), and lower baseline LVMI (OR, 0.85 for each 10-g/m2; P = 0.011) in predicting LVG. Thus, after adjusting for baseline LVMI, Hgb level and systolic blood pressure remain independently important predictors of LVG. We defined the important modifiable risk factors. There remains a critical need to establish optimal therapeutic strategies and targets to improve clinical outcomes.