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The prognostic importance of left ventricular geometry in uremic cardiomyopathy
R N Foley1, P S Parfrey, J D Harnett
1Division of Nephrology, Memorial University, St John's, Newfoundland, Canada.
Insights
Left ventricular (LV) mass and mass-to-volume ratio predict mortality in dialysis patients with normal LV cavity volume. In dilated ventricles, LV volume and low mass-to-volume ratio are key mortality predictors.
Area of Science:
- Cardiology
- Nephrology
- Echocardiography
Background:
- Left ventricular (LV) abnormalities are common in end-stage renal disease (ESRD) patients.
- The prognostic significance of LV mass, volume, and mass-to-volume ratio in chronic dialysis patients requires further elucidation.
Purpose of the Study:
- To investigate the association between LV mass, volume, and mass-to-volume ratio with all-cause mortality in patients undergoing chronic dialysis.
Main Methods:
- A multicenter, prospective inception cohort study included 433 dialysis patients with baseline echocardiograms.
- Patients were followed for a median of 41 months.
- Statistical analyses adjusted for clinical and laboratory confounders.
Main Results:
- In patients with normal LV cavity volume and systolic function, high LV mass index and mass-to-volume ratio were independent predictors of late mortality.
- In patients with LV dilation and normal systolic function, high LV cavity volume and low mass-to-volume ratio were independent predictors of late mortality.
- Echocardiographic classification based on LV mass and cavity volume was the strongest predictor of late mortality.
Conclusions:
- LV geometry and remodeling significantly impact mortality risk in chronic dialysis patients.
- Specific echocardiographic parameters hold prognostic value depending on the underlying LV cavity size and systolic function.
- Echocardiography is a powerful tool for risk stratification in ESRD patients.
Abstract:
The objective of this study was to determine the effect of left ventricular (LV) mass, volume, and mass-to-volume ratio on mortality in chronic dialysis patients. The Design was a multicenter, prospective inception cohort study with a median follow-up of 41 months. The Setting was three university-affiliated nephrology units. A total of 433 patients who (1) survived > 6 months from the start of ESRD therapy and (2) had a technically satisfactory baseline echocardiogram were studied. Measurements included a baseline clinical, laboratory and echocardiographic assessment. LV hypertrophy was present in 74% and LV dilation was present in 36% of patients. In patients with normal cavity volume (< or = 90 mL/m2) and normal systolic function, high LV mass index (> 120 g/m2) and mass-to-volume ratios (> 2.2 g/mL) were independently associated with late mortality (> 2 yr after starting dialysis therapy). After adjusting for baseline age, diabetes, and ischemic heart disease, the relative risk for the former was 3.29 and for the latter was 2.24. Cavity volume was of no prognostic significance in this group. In patients with LV dilation and normal systolic function, high cavity volume (> 120 mL/m2) and low mass-to-volume ratio (< 1.8 mL/m2) were independently associated with late mortality, the relative risk in the former being 17.14 and the latter being 4.27. LV mass index was of no prognostic significance in this group. The baseline echocardiographic classification, based on LV mass and cavity volume, was the strongest predictor of late mortality, after adjusting for age, gender, diabetes mellitus, coronary artery disease, angina pectoris, chronic hypertension, and hemoglobin and serum albumin levels.(ABSTRACT TRUNCATED AT 250 WORDS)