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Patterns of left ventricular hypertrophy in chronic kidney disease: an echocardiographic evaluation
Ravinder S Sambi1, A K Gaur, R Hotchandani
1Department of Medicine and Cardiology, Moolchand Medcity, Escorts Heart Institute, JROP Healthcare, Metro Heart, New Delhi, India.
Insights
Left Ventricular Hypertrophy (LVH) prevalence increases with chronic kidney disease (CKD) severity, particularly concentric hypertrophy. Early intervention for concentric remodeling may prevent LVH progression in CKD patients.
Area of Science:
- Cardiology
- Nephrology
- Medical Diagnostics
Background:
- Chronic kidney disease (CKD) is associated with increased cardiovascular disease (CVD) risk.
- Left Ventricular Hypertrophy (LVH) is a common complication in CKD patients.
- Understanding LVH patterns in CKD is crucial for predicting CVD and mortality.
Purpose of the Study:
- To evaluate the prevalence and patterns of LVH in CKD patients with varying degrees of uremia.
- To identify echocardiographic predictors of CVD, morbidity, and mortality in CKD.
- To assess the relationship between CKD severity and LVH development.
Main Methods:
- Prospective study involving 75 subjects (20-65 years) divided into three groups: healthy controls, mild-to-moderate CKD, and severe CKD.
- CKD diagnosis based on serum creatinine (sCr) > 1.5 mg/dl and estimated glomerular filtration rate (GFR) < 60 ml/min/1.73 m2.
- Echocardiographic assessment to determine LVH prevalence, patterns (concentric remodeling, concentric hypertrophy, eccentric hypertrophy), and left ventricular mass index (LVMI).
Main Results:
- LVH prevalence increased significantly with CKD severity (64% in mild/moderate CKD to 96% in severe CKD).
- Mean LVMI was significantly higher in CKD patients compared to controls, and further elevated in severe CKD.
- Concentric hypertrophy was significantly more prevalent in severe CKD patients (68%) compared to mild/moderate CKD (40%).
Conclusions:
- LVH prevalence and severity, particularly concentric hypertrophy, are directly related to CKD progression.
- Concentric remodeling in CKD patients predicts progression to concentric or eccentric hypertrophy.
- Early medical intervention targeting concentric remodeling may prevent the advancement of LVH in CKD.
Background:
We evaluated the chronic kidney disease (CKD) patients having different degree of uremia for the prevalence of Left Ventricular Hypertrophy (LVH), different patterns of left Ventricular Hypertrophy by echocardiographic variables to define the most sensitive and powerful predictor of cardiovascular disease (CVD) and premature morbidity and mortality.
Methods:
We used clinical and biochemical data from the prospective study done by us to evaluate "The Echocardiographic assessment of cardiac functions in patients with chronic kidney disease". The diagnosis of CKD was made on the basis of serum creatinine (sCr) concentration of more than 1.5 mg/dl, persistent and with no evidence of recovery over a period of 3 months. Glomerular filtration rate (GFR) was calculated by the Modification of Diet in Renal Disease (MDRD) equation and cut-off for CKD was taken to be < 60 ml/min/1.73 m2 as per existing guidelines. The study population consisted of a total of 75 subjects divided into three groups of 25 subjects each, all between the age of 20-65 yrs:
Group A:
Healthy normal controls (sCr < 1.5 mg/dl);
Group B:
Patients with mild to moderate CKD (sCr 1.5 - 6.0 mg/dl); GROUP C: Patients with severe CKD (sCr > 6.0 mg/dl).
Results:
A progressive rise in prevalence of LVH was observed with the severity of kidney disease from 64% (mild/ moderate CKD group) to 96% (severe CKD group) and higher prevalence of LVH in females than males in the severe CKD group. The mean LVMI in both the groups of CKD was significantly higher than the healthy controls (76.62 +/- 10.97). Also, mean LVMI in severe CKD (139.23 +/- 17.47) patients was significantly higher than in mild/moderate CKD (114.91 +/- 15.20) patients. The prevalence of concentric remodeling in both the CKD groups was alike (20%). While that of concentric hypertrophy in severe CKD patients (68%) was significantly higher than in mild/moderate CKD group (40%) (p < 0.05), but no significant difference was observed for eccentric pattern of hypertrophy between the two CKD groups. This suggests that concentric hypertrophy is more prevalent in CKD patients.
Conclusions:
The mean left ventricular mass index (LVMI) showed a proportionate increase with the severity of renal failure and a progressive rise with increase in severity of disease. Patients of CKD groups revealed occurrence of concentric remodeling which is a predictor of high vulnerability for progressing into concentric and eccentric hypertrophy. Hence early medical intervention may reverse the concentric remodeling, thereby preventing the advancement to concentric or eccentric LVH.
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