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Estimated Glomerular Filtration Rate and Systolic Time Intervals in Risk Stratification for Increased Left
Wen-Hsien Lee1, Po-Chao Hsu, Chun-Yuan Chu
1From the Graduate Institute of Clinical Medicine (W-HL, S-CC), Faculty of Medicine, College of Medicine (W-HL, P-CH, C-YC, S-CC, C-SL, H-WY, T-HL, W-CV, S-HS, H-MS), Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital (W-HL, P-CH, C-YC, H-HL, M-KL, C-SL, H-WY, T-HL, W-CV, W-TL, S-HS, H-MS), and Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC (W-HL, S-CC, M-KL, H-MS).
Insights
Combining kidney function (eGFR) and systolic time intervals (bPEP/bET) effectively identifies patients at higher risk for left ventricular hypertrophy (LVH) and increased left ventricular mass index (LVMI). This combined approach aids in cardiac risk stratification.
Area of Science:
- Cardiology
- Nephrology
- Clinical Medicine
Background:
- Decreased renal function and increased systolic time intervals are independently linked to cardiac hypertrophy and adverse cardiac outcomes.
- Left ventricular mass index (LVMI) and left ventricular hypertrophy (LVH) are critical indicators of cardiac health.
- Systolic time intervals, including the brachial pre-ejection period (bPEP) and brachial ejection time (bET), offer insights into cardiac function.
Purpose of the Study:
- To investigate the combined association of renal function and brachial systolic time intervals with LVMI and LVH.
- To evaluate the utility of a combined parameter (eGFR and bPEP/bET ratio) for risk stratification of cardiac hypertrophy.
- To identify patient subgroups with increased risk for adverse cardiac remodeling.
Main Methods:
- A cohort of 990 patients was classified into four groups based on estimated glomerular filtration rate (eGFR) and the bPEP/bET ratio.
- Group 1: eGFR ≥ 45 mL/min/1.73 m² and bPEP/bET < 0.38.
- Group 2: eGFR ≥ 45 mL/min/1.73 m² and bPEP/bET ≥ 0.38. Group 3: eGFR < 45 mL/min/1.73 m² and bPEP/bET < 0.38. Group 4: eGFR < 45 mL/min/1.73 m² and bPEP/bET ≥ 0.38.
- Multivariable analyses were performed to assess the association with LVMI and LVH.
Main Results:
- Patients in Group 4 exhibited the highest LVMI, while those in Group 1 had the lowest (P < 0.001).
- Increased LVMI and LVH were significantly associated with patients in Groups 2, 3, and 4 compared to Group 1 (P ≤ 0.019).
- The combined assessment of eGFR and bPEP/bET ratio demonstrated a clear gradient of risk for cardiac hypertrophy.
Conclusions:
- The combination of renal function (eGFR) and systolic time intervals (bPEP/bET) serves as a valuable tool for risk stratification.
- This integrated parameter may offer an alternative method for identifying individuals at risk for increased LVMI and LVH.
- Early identification of high-risk patients through this combined approach can potentially guide clinical management and improve cardiac outcomes.
Abstract:
Either decreased renal function or increased systolic time interval is associated with cardiac hypertrophy and poor cardiac outcome. The aim of this study was to evaluate combination of renal function and brachial systolic time intervals were associated with increased left ventricular mass index (LVMI) and left ventricular hypertrophy (LVH).In total of 990 patients were consecutively included in this study from January 2011 to December 2012. All study participants were further classified into 4 groups by the values of estimated glomerular filtration rate (eGFR) and ratio of brachial preejection period (bPEP) to brachial ejection time (bET). The classification of 4 groups were eGFR ≥ 45 mL/min/1.73 m and bPEP/bET < 0.38 (group 1), eGFR ≥ 45 ml/min/1.73 m and bPEP/bET ≥ 0.38 (group 2), eGFR < 45 mL/min/1.73 m and bPEP/bET < 0.38 (group 3), and eGFR < 45 mL/min/1.73 m and bPEP/bET ≥ 0.38 (group 4), respectively. Patients in groups 1 and 4 had the lowest and highest LVMI among 4 groups, respectively (P < 0.001). In multivariable analyses, increased LVMI and LVH were significantly associated with patients in groups 2, 3 and 4 (vs group 1) (P ≤ 0.019).Our study demonstrated that joined parameter of renal function and systolic time intervals, in terms of eGFR and bPEP/bET, might be an alternative method in risk stratification for increased LVMI and LVH.
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