Associations of Left Ventricular Hypertrophy and Geometry with Adverse Outcomes in Patients with CKD and Hypertension
| Autor: | Simone Vettoretti, Ernesto Paoletti, Paolo Cassottana, Sergio Lucà, Francis B. Gabbai, Laura Pieracci, Luca De Nicola, Paolo Chiodini, Sonia Marre, Silvio Borrelli, Maura Ravera, Roberto Minutolo, Giuseppe Conte |
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| Přispěvatelé: | Paoletti, Ernesto, DE NICOLA, Luca, Gabbai, Francis B, Chiodini, Paolo, Ravera, Maura, Pieracci, Laura, Marre, Sonia, Cassottana, Paolo, Lucà, Sergio, Vettoretti, Simone, Borrelli, Silvio, Conte, Giuseppe, Minutolo, Roberto |
| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
Male
Time Factors Epidemiology 030232 urology & nephrology Geometry Blood Pressure 030204 cardiovascular system & hematology Critical Care and Intensive Care Medicine Left ventricular hypertrophy Kidney 0302 clinical medicine Risk Factors Odds Ratio Prevalence Medicine echocardiography Prospective Studies Prospective cohort study Ventricular Remodeling Hazard ratio Middle Aged hypertrophy left ventricular blood pressure monitoring ambulatory female left ventricular geometry Italy Nephrology Cardiology Disease Progression Glomerular Filtration Rate Adult medicine.medical_specialty Ambulatory blood pressure hypertension Renal function follow-up studie Risk Assessment 03 medical and health sciences Predictive Value of Tests Internal medicine Humans cardiovascular diseases human Renal Insufficiency Chronic Ventricular remodeling Aged Proportional Hazards Models Transplantation Chi-Square Distribution business.industry Odds ratio Original Articles medicine.disease Blood pressure Logistic Models Multivariate Analysis Kidney Failure Chronic business chronic kidney disease |
| Popis: | Background and objectives Left ventricular hypertrophy (LVH) and abnormal left ventricular (LV) geometry predict adverse outcomes in the general and hypertensive populations, but findings in CKD are still inconclusive. Design, setting, participants, & measurements We enrolled 445 patients with hypertension and CKD stages 2–5 in two academic nephrology clinics in 1999–2003 who underwent both echocardiography and ambulatory BP monitoring. LVH (LV mass >100 g/m 2 [women] and >131 g/m 2 [men]) and relative wall thickness (RWT) were used to define LV geometry: no LVH and RWT≤0.45 (normal), no LVH and RWT>0.45 (remodeling), LVH and RWT≤0.45 (eccentric), and LVH and RWT>0.45 (concentric). We evaluated the prognostic role of LVH and LV geometry on cardiovascular (CV; composite of fatal and nonfatal events) and renal outcomes (composite of ESRD and all-cause death). Results Age was 64.1±13.8 years old; 19% had diabetes, and 22% had CV disease. eGFR was 39.9±20.2 ml/min per 1.73 m 2 . LVH was detected in 249 patients (56.0%); of these, 125 had concentric LVH, and 124 had eccentric pattern, whereas 71 patients had concentric remodeling. Age, women, anemia, and nocturnal hypertension were independently associated with both concentric and eccentric LVH, whereas diabetes and history of CV disease associated with eccentric LVH only, and CKD stages 4 and 5 associated with concentric LVH only. During follow-up (median, 5.9 years; range, 0.04–15.3), 188 renal deaths (112 ESRD) and 103 CV events (61 fatal) occurred. Using multivariable Cox analysis, concentric and eccentric LVH was associated with higher risk of CV outcomes (hazard ratio [HR], 2.59; 95% confidence interval [95% CI], 1.39 to 4.84 and HR, 2.79; 95% CI, 1.47 to 5.26, respectively). Similarly, greater risk of renal end point was detected in concentric (HR, 2.33; 95% CI, 1.44 to 3.80) and eccentric (HR, 2.30; 95% CI, 1.42 to 3.74) LVH. Sensitivity analysis using LVH and RWT separately showed that LVH but not RWT was associated with higher cardiorenal risk. Conclusions In patients with CKD, LVH is a strong predictor of the risk of poor CV and renal outcomes independent from LV geometry. |
| Databáze: | OpenAIRE |
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