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Chronic kidney disease elicits excessive increase in left ventricular mass growth in patients at increased risk for
Giovanni Cioffi1, Luigi Tarantini, Roberto Frizzi
1Echocardiography Laboratory, Villa Bianca Hospital, Trento, Italy. gcioffi@villabiancatrento.it
Insights
Inappropriate left ventricular mass (iLVM) is common in patients with chronic kidney disease (CKD). This study found a strong inverse relationship between iLVM and estimated glomerular filtration rate (eGFR), highlighting CKD's impact on cardiac health.
Area of Science:
- Cardiology
- Nephrology
- Biomedical Engineering
Background:
- Chronic kidney disease (CKD) is associated with left ventricular hypertrophy (LVH), but the exact mechanisms are not fully understood.
- Neuro-hormonal stressors in CKD may contribute to inappropriate left ventricular mass (iLVM).
- Limited data exist on the relationship between iLVM and renal function in CKD patients.
Purpose of the Study:
- To investigate the association between iLVM and the severity of CKD.
- To determine the prevalence of iLVM in individuals at increased cardiovascular risk with varying stages of CKD.
Main Methods:
- Echocardiography and estimated glomerular filtration rate (eGFR) were used to assess 340 individuals at high cardiovascular risk.
- Patients were categorized into stages 1-2 CKD (eGFR ≥60 ml/min per 1.73 m²) and stages 3-5 CKD (eGFR <60 ml/min per 1.73 m²).
- iLVM was defined as left ventricular mass (LVM) exceeding 28% of the predicted value based on height, sex, and stroke work.
Main Results:
- iLVM was detected in 43% of CKD patients versus 10% of controls.
- A significant inverse correlation was observed between the LVM/predicted LVM ratio and eGFR (r=0.54, P<0.001).
- iLVM prevalence increased with CKD severity, reaching 100% in stages 4-5 CKD.
Conclusions:
- iLVM is strongly associated with the presence and severity of CKD in patients at increased cardiovascular risk.
- The findings underscore the significant impact of CKD on cardiac remodeling.
- Further research is warranted to explore the prognostic implications of combined iLVM and CKD.
Background:
The hemodynamic alterations induced by the impairment of renal function explain only in part the development of left ventricular hypertrophy in patients with chronic kidney disease (CKD), who are theoretically exposed to an inappropriate high growth of left ventricular mass (iLVM) due to the activation of neuro-hormonal stressors. Few data are available on the relations between iLVM and renal function.
Study Design And Measurements:
Three hundred and forty individuals at increased risk for cardiovascular events underwent assessment of renal function by the estimation of glomerular filtration rate (eGFR) and echocardiography: 227 patients had stages 1-2 CKD (eGFR ≥60 ml/min per 1.73 m), and 113 stages 3-5 (eGFR <60 ml/min per 1.73 m). LVM was predicted in each patient from height, sex and stroke work using a validated equation. iLVM was defined as LVM more than 28% of the predicted value. Sixty-eight healthy individuals served as controls.
Results:
iLVM was detected in seven controls (10%) and in 146 study patients (43%). There was an inverse relation between observed/predicted LVM ratio and eGFR (r 0.54, P < 0.001). In linear regression analysis, iLVM was related to eGFR (β 0.40), relative wall thickness (β 0.29), diabetes (β 0.14), and maximal left atrial volume (β 0.25) (all P < 0.001). Prevalence of iLVM was 10% in patients in stage-1 CKD, 31% in stage 2, 67% in stage 3, and 100% in stages 4 and 5.
Conclusion:
In patients at increased risk for cardiovascular events, iLVM is strongly related to the presence and magnitude of CKD. Further longitudinal studies are needed to evaluate the prognostic value of the coexistence of iLVM and CKD.
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