Left ventricular hypertrophy and geometry in hypertensive patients with chronic kidney disease

Nardi, Emilio; Palermo, Alessandro; Mulè, Giuseppe; Cusimano, Paola; Cottone, Santina; Cerasola, Giovanni

doi:10.1097/hjh.0b013e3283220ecd

Cited by 96 publications

(110 citation statements)

References 47 publications

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“…In contrast, diastolic dysfunction (defined in this study as decreased E/A and prolonged deceleration time) was promoted by both CKD and diabetes, and the impact of diabetes appeared somewhat stronger than that of CKD. 8 Our study, in agreement with our previous results, 1,7 confirms that renal function is associated with impaired diastolic function and is independently related with Em, a parameter that has been demonstrated to be inversely related to the degree of fibrosis in ischemic, as well as in normal myocardial segments. 24 Moreover, in our study, also type 2 diabetes was independently associated with Em, and patients with diabetes had significantly lower Em values in comparison with non-diabetic patients.…”

Section: Discussionsupporting

confidence: 91%

“…Left ventricular hypertrophy (LVH), a frequent expression of subclinical target-organ damage related to hypertension, is a very common structural abnormality in patients with chronic kidney disease (CKD), [1][2][3] and is independently associated with cardiovascular (CV) morbidity and mortality. 4,5 LV diastolic dysfunction is also frequent among CKD patients and is associated with the risk to develop heart failure and with mortality.…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, in hypertensive patients with CKD, LVH is often characterized by the simultaneous increase of LV-wall thicknesses, internal diameters, relative wall thickness (RWT), and diastolic function is worse in comparison with hypertensive patients with normal renal function. 1 In the present study we evaluate the impact of type 2 diabetes on LV hypertrophy, geometry and diastolic function in a group of hypertensive patients with CKD.…”

Section: Introductionmentioning

confidence: 99%

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Impact of type 2 diabetes on left ventricular geometry and diastolic function in hypertensive patients with chronic kidney disease

et al. 2010

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Left ventricular hypertrophy (LVH) and diastolic dysfunction are very common in patients with chronic kidney disease (CKD). Aim of this study was to evaluate the impact of type 2 diabetes on LV geometry and diastolic function in hypertensive patients with CKD. We enrolled 288 Caucasian subjects with hypertension and CKD; of them, 112 had diabetes. Patients with cardiovascular (CV) diseases, glomerular filtration rate (GFR) 460 ml min À1 per 1.73 m 2 , dialysis treatment and other major non-CV diseases were excluded. All patients underwent routine biochemical analyses and echocardiographic examination with tissue Doppler imaging (TDI). Patients with diabetes had significantly higher LV wall thicknesses (P ¼ 0.0001), relative wall thickness (RWT) (P ¼ 0.0001) and left atrium volume index (P ¼ 0.03), when compared with patients without diabetes. Further, diabetic patients had very high prevalence of concentric LVH. Em, evaluated by TDI, was significantly lower in patients with diabetes (P ¼ 0.005). However, the difference lost statistical significance after correction by analysis of covariance for RWT. Multiple stepwise linear regression analysis showed that the variables independently associated with Em were: age (b 0.364; P ¼ 0.0001), GFR (beta 0.101; P ¼ 0.019), and the presence of diabetes (b 0.166; P ¼ 0.002). Our study showed that in hypertensive patients with CKD the presence of diabetes is associated with increased LV-wall thicknesses and concentric geometry; further, diabetes together with renal function (GFR) is associated with worse diastolic function, independently of potential confounders, such as age, gender, body mass index and blood pressure.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of type 2 diabetes on left ventricular geometry and diastolic function in hypertensive patients with chronic kidney disease

et al. 2010

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“…5 To compensate for the hemodynamic and metabolic alterations, an excessive increase in the left ventricular mass (LVM), a condition that has been termed 'inappropriate LVM' , is frequently found in patients with CKD. 6 The predicted LVM based on sex, height 2,7 and hemodynamic load can be used as an appropriate reference for the observed LVM. 7,8 The appropriateness of the LVM can be estimated by the ratio of the observed LVM to the predicted LVM.…”

Section: Introductionmentioning

confidence: 99%

“…6 The predicted LVM based on sex, height 2,7 and hemodynamic load can be used as an appropriate reference for the observed LVM. 7,8 The appropriateness of the LVM can be estimated by the ratio of the observed LVM to the predicted LVM. Recently, the presence of inappropriate LVM has been found in a significant proportion of patients with arterial hypertension or aortic stenosis and has been reported to have a negative impact on cardiovascular prognosis.…”

Section: Introductionmentioning

confidence: 99%

The ratio of observed to predicted left ventricular mass is independently associated with increased cardiovascular events in patients with chronic kidney disease

et al. 2012

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A condition involving the growth of the myocardium that exceeds hemodynamic needs has been reported and called as inappropriate left ventricular mass (LVM). The appropriateness of LVM can be estimated by the ratio of observed LVM to predicted LVM. The excessive growth of LVM is frequently noted in patients with chronic kidney disease (CKD). This study is designed to assess whether the ratio of observed to predicted LVM is a useful prognostic indicator of cardiovascular events in patients with moderate to advanced CKD. We consecutively enrolled 485 patients with CKD stages 3-5 from our Outpatient Department of Internal Medicine. Inappropriate LVM was defined as observed LVM more than 28% greater than the predicted value. The relative risk of cardiovascular events was analyzed by Cox-regression methods. There was a significant trend for a stepwise increase in the observed/predicted LVM ratio (Po0.001) and the prevalence of inappropriate LVM (P ¼ 0.003) corresponding to advances in CKD stages. In the multivariate analysis, old age, a history of coronary artery disease, congestive heart failure, atrial fibrillation, wide pulse pressure, decreased serum albumin and hemoglobin levels, left atrial diameter 44.7 cm and increased observed/predicted LVM were independently associated with increased cardiovascular events. Our findings show that increased observed/predicted LVM is independently associated with adverse cardiovascular outcomes in patients with CKD stages 3-5.

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Association of mild kidney dysfunction with diastolic dysfunction and heart failure with preserved ejection fraction

Vernooij,

van Ommen,

Valstar

et al. 2023

ESC Heart Failure

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AimsWe aim to investigate the association between kidney dysfunction and left ventricular diastolic dysfunction parameters and heart failure with preserved ejection fraction (HFpEF) and whether this is sex‐specific.Methods and resultsWe included participants from the HELPFul observational study. Outpatient clinical care data, including echocardiography, and an expert panel judgement on HFpEF was collected. Estimated glomerular filtration rate (eGFR) was calculated by creatinine and cystatin C without race. The association between eGFR with E/e′, left ventricular mass index, relative wall thickness, and stage C/D heart failure was tested by multivariable adjusted regression models, stratified by sex, reporting odds ratios and 95% confidence intervals (95% confidence interval). We analysed 880 participants, mean age 62.9 (standard deviation: 9.3) years, 69% female. Four hundred six participants had mild (37.6%) kidney dysfunction (eGFR: 60–89 mL/min/1.73 m2) or moderate (8.5%) kidney dysfunction (eGFR: 30–59 mL/min/1.73 m2). HFpEF was significantly more prevalent in participants with mild and moderate kidney dysfunction (10.3% and 16.0%, respectively) than participants with normal kidney function (3.4%). A lower kidney function was associated with higher E/e′ and higher relative wall thickness values. Participants with moderate kidney dysfunction had a higher likelihood of American College of Cardiology/American Heart Association stage C/D HF (odds ratio: 2.07, 95% confidence interval: 1.23, 3.49) than participants with normal kidney functions.ConclusionsBoth mild and moderate kidney dysfunction are independently associated with left ventricular diastolic dysfunction parameters and HFpEF. This association is independent of sex and strongest for moderate kidney dysfunction. Considering mild‐to‐moderate kidney dysfunction as risk factor for HFpEF may help identify high‐risk groups benefiting most from early intervention.

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Left ventricular hypertrophy and geometry in hypertensive patients with chronic kidney disease

Abstract: Our study confirms that LVH is highly prevalent in patients with CKD; in this population, LVH is often inappropriate and characterized by the simultaneous increase of wall thicknesses and diameters.

Cited by 96 publications

References 47 publications

Impact of type 2 diabetes on left ventricular geometry and diastolic function in hypertensive patients with chronic kidney disease

Impact of type 2 diabetes on left ventricular geometry and diastolic function in hypertensive patients with chronic kidney disease

The ratio of observed to predicted left ventricular mass is independently associated with increased cardiovascular events in patients with chronic kidney disease

Association of mild kidney dysfunction with diastolic dysfunction and heart failure with preserved ejection fraction

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