Left ventricular remodeling in IgA nephropathy: Prognostic implications and clinical correlations

The determinants and prognosis of left ventricular (LV) geometric remodeling remain uncharacterized in immunoglobulin A nephropathy (IgAN). We investigated the (1) clinicopathological correlates of LV hypertrophy (LVH), (2) longitudinal evolution of LV geometry, and (3) associations of LVH phenotypes with cardiorenal outcomes.

In this retrospective study, 683 adults with biopsy-proven primary IgAN (2013-2021) underwent comprehensive echocardiographic phenotyping. Multivariable Cox regression modeled associations of baseline LV geometry with a composite renal endpoint (50 % estimated glomerular filtration rate [eGFR] decline or kidney failure) and a cardiovascular endpoint (major adverse cardiovascular events [MACE]).

Among 683 patients, 60 (8.8 %) had LVH at baseline. Age, hypertension, proteinuria, eGFR, and arteriolar hyalinosis were significant risk factors for LVH. Hemoglobin (hazard ratio = 1.03, P = 0.043) and endocapillary hypercellularity (hazard ratio = 2.87, P = 0.017) were significant risk factors for LVH deterioration. The most critical finding was that compared with normal LV geometry, concentric hypertrophy conferred a 4.14-fold renal risk (95 % confidence interval [CI]: 1.02-16.75, P = 0.047), while eccentric hypertrophy predicted a 3.42-fold MACE risk (95 % CI: 1.08-10.8, P = 0.036) independent of clinicopathological confounders.

In IgAN, age, hypertension, proteinuria, eGFR, and arteriolar hyalinosis are risk factors for LVH, while hemoglobin and endocapillary hypercellularity accelerate LVH progression. The key finding was that concentric LV remodeling signals renal risk, whereas eccentric hypertrophy independently portends MACE.