Predictors of left ventricular hypertrophy in patients with chronic kidney disease

The aim of the present study is to determine the prevalence and predictors of left ventricular hypertrophy in patients with stage 3 or 4 chronic kidney disease. Thirty-four patients were included. In addition to hematological and biochemical evaluations, echocardiography and ambulatory blood pressure monitoring were performed both at the beginning and at the end of the first year. Echocardiographic left ventricular mass was calculated and indexed to body surface area to calculate left ventricular mass index (LVMI). Left ventricular hypertrophy was diagnosed if LVMI >131 g/m(2) in male and >100 g/m(2) in female patients. During the follow-up period, estimated glomerular filtration rate decreased from 36.6+/-11.7 to 31.0+/-14.0 mL/min (p = 0.03), while LVMI increased from 130.2+/-35.6 to 140.5+/-30.5 g/m(2) (p = 0.055). Left ventricular hypertrophy was detected in 67.6% of the patients at the baseline and in 89.7% at the end of the study (p = 0.011). The independent predictors of the final LVMI were age (p = 0.035), baseline day-time systolic blood pressure (p = 0.01), baseline C-reactive protein (p = 0.001), and the decrease in glomerular filtration rate during the follow-up (p = 0.002). Left ventricular hypertrophy is quite frequent among patients with stage 3 or 4 chronic kidney disease, and its prevalence increases while glomerular filtration rate decreases during the follow-up. The early detection of left ventricular hypertrophy and both prevention of the deterioration of renal function and aggressive blood pressure control may help to achieve a decrease in cardiovascular morbidity and mortality in these patients.     

Relationship between aortic valve sclerosis and left ventricular hypertrophy in chronic haemodialysis patients

Background Cardiac valve calcification is a frequent finding in chronic haemodialysis patients. Left ventricular hypertrophy (LVH) is a significant predictor of cardiovascular mortality in patients with end-stage renal disease. We evaluated the influence of aortic valve sclerosis (AVS) on the development of LVH in chronic haemodialysis patients. Methods A total of 82 consecutive patients (52 male, mean age 48 ± 12 years) undergoing chronic haemodialysis treatment for >1 year were subjected to echocardiography for the screening of AVS and the assessment of transaortic flow velocity and the left ventricular mass index (LVMI). The absence (group 1, n = 42) and presence of AVS (group 2, n = 40) was established. The average values of systolic, diastolic and pulse pressure were obtained. Plasma calcium, phosphorus, intact parathyroid hormone, C-reactive protein, haemoglobin and lipid levels were also measured. Results LVH was detected in 59 (72%) of the study patients. The LVMI was higher in the AVS group (171 ± 39 vs. 132 ± 41 g/m², p < 0.001). Patients with AVS also had higher transaortic flow velocities (1.64 ± 0.36 vs. 1.21 ± 0.21 m/s, p < 0.01) and maximal pressure gradients (10.8 ± 7.1 vs. 5.9 ± 3.4 mmHg, p < 0.01). The LVMI showed a direct correlation with transaortic flow velocity in the AVS group (r = 0.60, p < 0.01). Stepwise linear regression analysis revealed transaortic flow velocity (p = 0.02), pulse pressure (p = 0.01) and haemoglobin levels (inverse relationship) (p = 0.02) to be independent predictors of the LVMI. Conclusion These data suggest that AVS is strongly and independently interrelated with LVH in chronic haemodialysis patients. The underlying mechanism might be the valve resistance to left ventricular outflow, as shown by increased transaortic flow velocities and maximal pressure gradients in AVS patients.     

Left ventricular mass and cardiac function in a population of children with chronic kidney disease

Background

Cardiovascular disease (CVD) is a common cause of morbidity and mortality in children with chronic kidney disease (CKD). Left ventricular hypertrophy (LVH) and diastolic dysfunction (LVDD) are early markers. The aims of this study were to evaluate (1) LVH and LVDD, using both conventional echocardiographic evaluation and Tissue Doppler Imaging (TDI), and (2) the correlation between cardiac disease and possible risk factors, in children with CKD.

Methods

The study cohort comprised 34 paediatric patients with CKD and 34 healthy children (mean ± standard deviation: age 9?±?4.6 and 8.2?±?4.3 years, respectively). Thirteen (38 %) patients were in CKD stage 2, 15 (44 %) in stage 3 and six (18 %) in stage 4–5. LVH was defined as a left ventricular mass index (LVMI) of >95th percentile (38 g/h^2.7).

Results

Left ventricular hypertrophy was present in 13 patients (38 %). Diastolic function evaluated with TDI (E′/A′ = early/late diastolic myocardial velocity) worsened with the reduction of glomerular filtration rate (p?=?0.020). There was a positive correlation between LVMI and body mass index-standard deviation score (p?=?0.020) and a negative correlation between E′/A′ and serum phosphorus and calcium levels and their respective product (p?=?0.004, p?=?0.017, p?<?0.001). The relaxation index E′ was reduced in 68 % of patients.

Conclusion

Based on our results, TDI is a simple procedure and would appear to be a more accurate diagnostic tool than conventional echocardiography in the early diagnosis of LVDD.     

Cardiac impact of the arteriovenous fistula after kidney transplantation: a case‐controlled,match‐paired study

In kidney transplant (KT) recipients, cardiac impact of the persistence of an asymptomatic arteriovenous fistula (AVF) for hemodialysis has not been fully elucidated. Seventy‐six patients (mean age: 49 years) without history of diabetes or cardiovascular disease underwent an echocardiography. Thirty‐eight had a functioning AVF and were match‐paired for age, gender and KT duration. Left ventricular mass index (LVMI) was significantly higher in patients with functioning AVF: 135.1 ± 30.3 vs. 112.4 ± 28 g/m² (P = 0.001). Exposure to AVF increased the risk of developing high LVH fourfold. Search for a dose‐effect of AVF flow revealed a trend towards increasing LVMI with higher flow: 142.6 ± 30 vs. 126.9 ± 23.9 g/m² (P = 0.084) (median flow of the population as cut‐off). Other significant changes were observed in left ventricular dimensions: greater end diastole‐ and systole diameters, both larger left and right atria, and left atrium diameter. Our study suggests that, in stable asymptomatic KT patients, functioning AVF has significant impact on cardiac mass, cardiac index and left ventricular dimensions. The effects on morbidity and mortality were to be investigated.     

Exercise-induced Wall Motion Abnormalities and Resting Left Ventricular Dysfunction in the Morbidly Obese as Assessed by Radionuclide Ventriculography

Rest and exercise first pass radionuclide ventriculograms were obtained in 62 morbidly obese subjects (56 women, six men, mean age 38 years, mean weight 269.2 ± 46.0 lb, mean height 65.2 ± 3.1 in., mean Body Mass Index 44.5 ± 6.2 kg/m², mean excess body weight 134.1 ± 41.1 lb) scheduled for vertical banded gastroplasty. Fifty-six percent demonstrated exercise-induced wall motion abnormalities mimicking coronary disease, compared to 12% of controls (p = 0.03). No subject with exercise-induced abnormalities had coronary disease at cardiac catheterization although only those with an anginal chest pain history underwent angiography. Twenty-six percent demonstrated resting left ventricular systolic dysfunction as manifested by a reduced resting left ventricular ejection fraction (<0.50). Thirty-one percent of these patients demonstrated exercise-induced abnormalities, versus 65% of morbidly obese subjects with normal resting ejection fractions (p = 0.04). Obesity-induced left ventricular hypertrophy with associated reduced coronary vasodilator reserve could explain the abnormalities. Six month post-gastroplasty follow-up radionuclide ventriculograms show group normalization of the resting left ventricular ejection fraction in those with preoperative dysfunction, possibly due to left ventricular unloading with some regression of hypertrophy.     

Septic and Aseptic Olecranon Bursitis in Patients on Maintenance Hemodialysis

Background. Left ventricular hypertrophy (LVH) is an important predictor of mortality in dialysis patients. The loss of residual renal function (RRF) appears to occur more rapidly in hemodialysis than continuous ambulatory peritoneal dialysis (CAPD). It is more likely that volume expansion in patients on CAPD may preserve RRF. The aim of this study was to investigate whether there is a cause–effect relationship between volume overload and preserving RRF in new hemodialysis patients. Methods. Nineteen patients with end‐stage renal disease (ESRD) starting hemodialysis therapy were included in the study. At the beginning, their elevated blood pressures (BP) were treated with antihypertensive drugs. Thereafter, until normovolemia and normal BP were obtained, strict volume control was applied. The effects of both treatment modalities on the loss of RRF and LVH were evaluated prospectively. Results. At the initial examination, all of the patients were hypertensive and had markedly increased left ventricular mass index (LVMI). The daily urine production was 1575 ± 281 mL. At the end of drug treatment period lasting three months, although BP significantly decreased, daily urine production and LVMI only decreased by 12% and 6%, respectively. At the end of the period in which strict volume control was applied, the body weight significantly decreased (from 60 ± 5 to 55 ± 8 kg, p < 0.0001). This decrease in body weight was accompanied by marked decreases in dilated cardiac chamber size and more importantly daily urine production. At the end of this period, while 7 of 19 patients had no residual urine production, residual urine production was below 200 mL/d in the remaining 12 patients. Although the period of volume control was short, there was significant reduction in the LVMI (decreased from 251 ± 59 to 161 ± 25 gr/m², p < 0.0001). Conclusion. The results of our prospective study have clearly shown that the persistence of residual renal function in patients with ESRD starting hemodialysis therapy may largely depend on volume overload. Equally interesting was the finding that despite significantly reduced BP level with hypotensive drugs, there was no marked regression in LVMI. In the contrary, after the volume control period, LVMI was significantly decreased. Our results support the hypotheses that decrease in volume may be more important than pressure reduction in regressing the left ventricular hypertrophy.     

Impact of Dry Weight Determined by Calf Bioimpedance Ratio on Carotid Stiffness and Left Ventricular Hypertrophy in Hemodialysis Patients

Our previous study has shown that modification of bioimpedance technique by the measurement of bioimpedance ratio in the calf (calf‐BR) was a simple and practical method in assessing fluid status in hemodialysis patients. However, the consequences of periodical dry weight (DW) adjustment under the guidance of calf‐BR on target organ damage have not been investigated. One hundred fifteen hemodialysis patients were enrolled in this pilot trial. Patients were divided into bioimpedance group and control group according to their dialysis schedule. In the bioimpedance group, DW was routinely adjusted under the guidance of calf‐BR every 3 months. In the control group, the assessment of DW remained a clinical judgment. Carotid stiffness, left ventricular mass index (LVMI), and calf‐BR were measured at baseline and at the 12th month in both groups. Home blood pressure (BP) was monitored monthly. Episodes of dialysis‐related adverse events were recorded. No significant differences were observed in parameters between the two groups at baseline. Compared with the control group, the bioimpedance group had significantly lower values in terms of the annual averages of systolic home BP (147.4 ± 15.3 mm Hg vs. 152.6 ± 16.9 mm Hg, P = 0.019), carotid stiffness index β (10.7 ± 3.3 vs. 12.2 ± 3.1, P = 0.003), LVMI (155.21 ± 15.64 g/m² vs. 165.17 ± 16.76 g/m², P < 0.001), and the percentage of individuals with calf‐BR over target range (P = 0.040) at month 12, with less annual averages of antihypertensive medications used and lower frequency of intradialytic hypotension, muscle cramps, or clotted angioaccess. Continued DW control achieved by periodical calf‐BR measurement improved arterial stiffness and left ventricular hypertrophy with good tolerability in hemodialysis patients.     

An Association Between Inflammatory State and Left Ventricular Hypertrophy in Hemodialysis Patients

This study was performed to investigate the potential relationship between left ventricular hypertrophy (LVH) and proinflammatory cytokines in hemodialysis (HD) patients and the effect of HD on cytokine production. Serum interleukin 1 beta (IL-1 β), interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-α) measurements and echocardiographic studies were performed in 35 stable HD patients. A variety of probable risk factors for LVH including age, HD duration, blood pressure (BP), body mass index, lipid profile, hemoglobin, albumin, parathormone and homocysteine levels were also investigated. Additionally, the effect of HD procedure on cytokine levels was evaluated. Predialysis serum levels of IL-1β, IL-6, TNF-α, and homocysteine in HD patients were compared with 12 healthy subjects. Left ventricular hypertrophy was demonstrated in 20 (57%) of HD patients by echocardiography. Left ventricular mass index (LVMI) was correlated positively with systolic BP (r = 0.556, p = 0.001), diastolic BP (r = 0.474, p = 0.004), and serum levels of TNF-α (r = 0.446, p = 0.009).Multiple regression analysis showed that systolic BP and TNF-α levels were significant independent predictors of LVH. No relationship was observed between LVH and other parameters. The mean predialysis serum level of IL-6 was significantly higher in HD patients compared to healthy controls (15.7 ± 8.7 vs. 7.3 ± 0.7 pg/mL, p = 0.001). Predialysis serum levels of TNF-α in HD patients were higher when compared to healthy subjects, but the difference was not statistically significant (8.3 ± 3 vs. 7 ± 1.45 pg/mL, respectively, p > 0.05). However, serum levels of IL-6 and TNF-α significantly elevated after HD, when compared to predialysis levels (from 15.7 ± 8.7 to 17.8 ± 9.5 pg/mL, p = 0.001 and from 8.3 ± 3.0 to 9.9 ± 3.5 pg/mL p = 0.004, respectively). As a conclusion, in addition to BP, proinflammatory cytokines, TNF-α in particular, seem to be associated with LVH in ESRD patients.     

Vitamin D receptor (VDR) gene polymorphism is associated with left ventricular (LV) mass and predicts left ventricular hypertrophy (LVH) progression in end‐stage renal disease (ESRD) patients

Left ventricular hypertrophy (LVH) is a strong cardiovascular risk marker in end‐stage renal disease (ESRD) patients. Vitamin D deficiency and/or disturbed vitamin D signaling has been implicated in LVH in experimental models. Because the BsmI vitamin D receptor VDR gene polymorphism may alter VDR function, we performed a cross‐sectional and longitudinal study in a cohort of 182 dialysis patients to investigate (1) the relationship between BsmI VDR gene polymorphism and left ventricular mass index (LVMI) measured by echocardiography and (2) the predictive power of this polymorphism for progression in LVH over a 18 ± 2 months of follow‐up. As a reference group, we used 175 healthy subjects matched to the study population as for age and sex. The distribution of BsmI genotypes did not significantly deviate from Hardy‐Weinberg equilibrium either in patients or in the control group of healthy subjects. The frequency of the B allele of BsmI polymorphism (40.4%) in dialysis patients was similar to that of healthy control subjects (38.6%), and the number of B alleles was directly related to LVMI (r = 0.20, P = .007). This relationship remained robust (β = 0.19, P = .006) in multivariate analysis adjusting for traditional and nontraditional risk factors and antihypertensive and calcitriol treatment. In the longitudinal study, LVMI rose from 60.1 ± 17.9 to 64.2 ± 19.3 g/m^2.7 (P < .001), and again, the number of B alleles was associated with LVMI changes both in crude and in fully adjusted analyses. These cross‐sectional and longitudinal observations coherently support the hypothesis that altered vitamin D signaling is implicated in LVH in ESRD patients. © 2010 American Society for Bone and Mineral Research     

Differences in Cardiac Structure Assessed by Echocardiography Between Renal Transplant Recipients and Chronic Kidney Disease Patients

BackgroundCardiovascular disease (CVD) is the leading cause of death in predialysis chronic kidney disease (CKD) and dialysis patients as well as in renal transplant recipients (RTRs). Left ventricular hypertrophy (LVH) starts early during the course of CKD and is a strong predictor of CVD in this population. Regression of LVH after a successful renal transplantation remains a debatable issue among investigators, whereas there is little data comparing echocardiographic measurements between patients with predialysis CKD and RTRs.AimThe aim of this study was to compare echocardiographic measurements of LV structure and function between predialysis CKD patients and RTRs of similar renal function level.Patients and MethodsWe conducted a case control study with individual (1:2) matching from the Renal Transplant and the predialysis CKD Outpatient Clinic. For each of the 36 RTRs, two matched for gender, age and estimated glomerular filtration rate (eGFR) predialysis CKD outpatients (72 patients) were included. All patients underwent transthoracic echocardiography and LV mass, LV mass index [LVM and LVMI = LVM/BSA g/m²] and indices of systolic function were measured. In a subgroup of 12 RTRs we retrospectively assessed and compared the LVMI measurements at three different time points, during predialysis, dialysis and post transplant period.ResultsThe prevalence of LVH was 33% in RTRs and 52% in CKD patients (ns). RTRs had significantly lower LVM and LVMI levels compared with predialysis CKD patients (P = .006 and P = .008) while the other echocardiographic indices did not differ. In the subgroup of 12 RTRs, post-transplant LVMI levels (105 ± 25 g/m²) were significantly lower in comparison with predialysis (147 ± 57 g/m²) and dialysis LVMI levels (169 ± 72 g/m²) (P = .01, P = .01, respectively).ConclusionRTRs had significantly lower LVMI compared with predialysis CKD patients of similar age, renal function, hemoglobin and blood pressure level.     

Evolution of left ventricular mass in renal transplant recipients: the influence of glucose homeostasis and oxidative stress

Background

Left ventricular hypertrophy, considered an independent factor for cardiovascular mortality, is frequent among renal transplant recipients (RTR), in whom we investigated changes in left ventricular mass (LVM) after grafting and associations with possible causal factors, especially glucose metabolism and oxidative stress.

Methods

We performed a prospective study of 37 RTR without prior diabetes mellitus who were evaluated at three times after transplantation (medians of 0.6, 16 and 28 months) by means of the LVM index (LVMI, echocardiographic measure of LVM related to body surface area, g/m²), oral glucose tolerance test and determinations of malondialdehyde and total glutathione (GSH), as well as glomerular filtration rate (GFR) estimate by the Modification of Diet in Renal Disease formula. We calculated the overall increment (DeltaLVMI) and percent change of LVMI. Patients were diagnosed to be prediabetic (PD) or new-onset diabetes after transplant (NODAT) according to ADA criteria.

Results

The mean LVMI decreased significantly over time among whole group baseline = 108.34 ± 27.71 g/m² versus middle: 100.03 ± 27.53 g/m² versus final: 90.62 ± 24.06 g/m² (P = .000). However, 13.5% of subjects showed an increased LVMI and 59.5%, a decrease less than 20%. Patients with NODAT at the end of the study showed a positive DeltaLVMI, which was negative in nondiabetics (0.24 ± 16.14 versus -19.86 ± 12.61 g/m², P = .018). Compared with DeltaLVMI(−) recipients, patients with DeltaLVMI(+) showed a greater proportion of PD and NODAT at baseline (60% and 40% versus 18.8% and 12.5%, P = .017), and significantly higher all-time fasting glycemia, lower estimated GFR, and greater increments of malondialdehyde and GSH over time. Those with a <20% LVMI decrease experienced progressive GFR impairment over time, as opposed to those with an LVMI decrease > 20%, who showed greater and improving GFR over the whole study.

Conclusions

LVMI does not always improve in RTR; the evolution of ventricular mass after renal transplantation is influenced by glucose metabolism disorders, oxidative stress, and graft function.     

Left ventricular mass index reduction early after an isolated aortic valve replacement with St Jude medical 19A-HP

Objectives: It has been reported that the left ventricular mass index (LVMI) for the hypertrophic myocardium is reduced at an early stage following surgery. In this study, those factors affecting the changes in early postoperative LVMI were investigated in cases in which a St. Jude Medical 19A-HP (19HP) mechanical heart valve was used.Methods: We studied 16 consecutive patients with pure aortic stenosis undergoing isolated aortic valve replacement using a 19HP between January 1994 and July 2001. The patients were all female, aged 64±6 years, with a body surface area of 1.44±0.10 m² and preoperative echocardiography at 4.2±3.3 days before and 16.3±10.2 days after operation, and cardiac catheterization within a mean epriod of one month before operation. The correlations between the decrease of LVMI at 16.3±10.2 days after operation and perioperative parameters were determined.Results: There was significant LVMI regression postoperative (15±12%,p=0.01), and only a significant negative correlation between the decrease of LVMI and preoperative left ventricular pressure (LVp) [r=−0.74,p<0.01]. There was, no effective LVMI reduction in the high preoperative LVp group (210 mmHg).Conclusion: It is expected that in the high LVp group, huge wall stress was being applied to the left ventricular muscle immediately before surgery and in the early period after surgery. Preoperative LVp is an important index for determining the surgical timing and safe perioperative management. We recommend early surgical treatment before LVp becomes more than 210 mmHg. Read at the 32nd Annual Meeting of the Japanese Society for Cardiovascular Surgery, Oral session, Osaka, February 14–16, 2002.     

Association between bioimpedance analysis parameters and left ventricular hypertrophy in peritoneal dialysis patients

Purpose

Chronic volume overload, hypertension and left ventricular hypertrophy are major risk factors contributing to the high mortality rate in peritoneal dialysis (PD) patients. In this study, we aimed to determine the impact of blood pressure measurements and volume status determined by bioelectrical impedance analysis (BIA) measurements over left ventricular hypertrophy (LVH) in PD patients.

Methods

Thirty-one prevalent PD patients were enrolled. Patients with a documented cardiovascular disease and uncontrolled hypertension were excluded. BIA and transthoracic echocardiography were performed in all patients All measurements were taken with the empty abdominal cavity. Routine laboratory parameters were also assessed in all patients. Extracellular water (ECW) in liters and ECW/total body water (TBW) ratio were used for determining volume status.

Results

Mean age of the patients was 43.9 ± 15.4 years, and mean PD duration was 39.5 ± 29.6 months. Mean ECW/TBW ratio was 44.3 %. Left ventricular mass index (LVMI) was 134.3 ± 34.9 g/m². Fifty-eight percent of patients had LVH. Mean LVMI was negatively correlated with daily urine volume (r ?0.568, p 0.001) and weekly Kt/V (r ?0.393, p 0.029); positively correlated with daily ultrafiltration (r +0.585, p 0.001) and office systolic (r +0.500, p 0.004) and diastolic (r +0.459, p 0.009) blood pressures. In linear regression analysis, daily urine volume (B ?0.426, p 0.002) mean diastolic blood pressure (B 0.550, p <0.001), ECW/TBW ratio (B 0.313, p 0.02) and waist circumference (B 0.304, p 0.016) were independent risk factors for LVH.

Conclusions

We want to underline that, besides maintaining residual renal function, strict blood pressure control, particularly diastolic blood pressure, and avoiding hypervolemia and abdominal obesity should be main clinical goals in follow-up of PD patients in order to prevent LVH progression.     

Cardiac output and associated left ventricular hypertrophy in pediatric chronic kidney disease

A significant number of children with chronic kidney disease (CKD) have eccentric left ventricular hypertrophy (LVH), suggesting the role of preload overload. Therefore, we hypothesized that increased cardiac output (CO) might be a contributing factor for increased left ventricular mass index (LVMI) in these children. Patients aged 6–20 years with CKD stages 2–4 were enrolled. Echocardiograms were performed to assess LV function and geometry at rest and during exercise. Heart rate, stroke volume, and CO were also assessed at rest and during exercise. Twenty-four-hour ambulatory blood pressure (AMBP) monitoring was performed. Of the patients enrolled in this study, 17% had LVH. Increased stroke volume and CO were observed in patients with LVH compared to patients without LVH. Univariate analysis revealed significant positive associations between LVMI and CO, stroke volume, body mass index, pulse pressure from mean 24-h AMBP, and mean 24-h systolic BP load. No association with heart rate, age, parathyroid hormone, glomerular filtration rate, or anemia was observed. Only CO (β = 1.98, p = 0.0005) was independently associated with increased LVMI in multivariate modeling (model R ² = 0.25). The results of this study suggest that increased CO might predispose to increased LVMI in pediatric patients with CKD. Adaptations may be required to meet increased metabolic demand in these patients.     

Left ventricular mass in hypertensive patients with mild‐to‐moderate reduction of renal function

Aim: Left ventricular hypertrophy (LVH) is an independent predictor of cardiovascular (CV) morbidity and mortality. The aim of the present study was to evaluate the relationship between LV mass and mild‐to‐moderate renal dysfunction in a group of non‐diabetic hypertensives, free of CV diseases, participating in the Renal Dysfunction in Hypertension (REDHY) study. Methods: Patients with diabetes, a body mass index (BMI) of more than 35 kg/m², secondary hypertension, CV diseases and a glomerular filtration rate (GFR) of less than 30 mL/min per 1.73 m² were excluded. The final sample included 455 patients, who underwent echocardiographic examination and ambulatory blood pressure monitoring. Results: There was a significant trend for a stepwise increase in LV mass, indexed by both body surface area (LVMI) and height elevated to 2.7 (LVMH^2.7), with the declining renal function, that remained statistically significant after correction for potential confounders. The prevalence of LVH, defined either as LVMI of 125 g/m² or more or as LVMH^2.7 of 51 g/m^2.7 or more, was higher in subjects with lower values of GFR than in those with normal renal function (P < 0.001 in both cases). The multiple regression analysis confirmed that the inverse association between GFR and LVM was independent of confounding factors. Conclusion: The present study confirms the high prevalence of LVH in patients with mild or moderate renal dysfunction. In the patients studied (all with a GFR of 30 mL/min per 1.73 m²), the association between LVM and GFR was independent of potential confounders, including 24 h blood pressure load. Taking into account the negative prognostic impact of LVH, further studies focusing on a deeper comprehension of the mechanisms underlying the development of LVH in chronic kidney disease patients are needed.     

Impact of early conversion from cyclosporin to everolimus on left ventricular mass index: A randomized controlled trial

This is an 18‐month prospective, randomized controlled trial (RCT) designed to compare the effect of early conversion from cyclosporin to everolimus/mycophenolic acid (E‐MPA) between 3 and 4 months post‐transplant to cyclosporin/mycophenolic acid (CsA‐MPA) on left ventricular mass index (LVMI) at 3 and 18 months post‐transplant (primary outcome). Secondary outcomes included estimated glomerular filtration rate (eGFR), viral infection, and adverse events. Twenty‐four patients were randomized in a 1:1 ratio to E‐MPA or CsA‐MPA groups. There were no significant differences in mean (SD) LVMI at 3 (51.6±18.5 vs 53.7±15.7 g/m^2.7) and 18 months (52.7±16.3 vs 51.7±16.8 g/m^2.7) between CsA‐MPA and E‐MPA groups. The incidence of viral infections was reduced in E‐MPA compared to CsA‐MPA treatment groups (8% vs 50%, P=.02), but the incidences of acute rejection, adverse events, and drug discontinuation were similar between groups. There was an overall increase in eGFR with time (0.04 log‐ mL/min/1.73 m² per 6 months, P=.012) but no significant difference between the two groups across time (0.11 log‐ mL/min/1.73 m², P=.311). Immunosuppressive regimen comprising early conversion from cyclosporine to everolimus was not associated with a regression of LVMI, but a lower risk of viral infections was observed.     

Impact of amlodipine or ramipril treatment on left ventricular mass and carotid intima-media thickness in nondiabetic hemodialysis patients

Objective: Left ventricular hypertrophy (LVH) and atherosclerosis are frequently observed in uremic patients and they have appeared as an independent predictor of cardiovascular morbidity and mortality. The aim of this study was to compare the effects of ramipril and amlodipine on left ventricular mass index (LVMI) and carotid intima-media thickness (CIMT) in nondiabetic hypertensive hemodialysis patients. Methods: A total of 112 hemodialysis (HD) patients were included in this study. Patients were randomly allocated to receive ramipril or amlodipine for 1 year. Blood pressure (BP) measurements, LVMI, and CIMT were assessed at baseline and 6-month intervals. Biochemical parameters and inflammatory markers were also determined at the initiation and during the study period. Results: Similar BP decrease was observed in treatment groups. During follow-up, LVMI and CIMT progressed likewise in both treatment groups despite BP control. However, subgrouping analyses due to the pattern of left ventricular geometry showed that LVMI in patients with eccentric LVH increased, whereas LVMI decreased in subjects with concentric LVH under antihypertensive treatment. Discussion: BP control with ramipril or amlodipine could not provide adequate protection for development or progression of atherosclerosis and eccentric type of LVH in nondiabetic HD patients.     

Ambulatory blood pressure monitoring and cardiac hypertrophy in children with metabolic syndrome

Background

The metabolic syndrome (MS), a cluster of potent risk factors for cardiovascular disease, is composed of insulin resistance, obesity, hypertension and hyperlipidemia. The aim of our study was to investigated the relationships between MS and left ventricular mass index (LVMI) in childhood MS. This study included 50 children and adolescents with MS aged between 7–18 years.

Methods

Thirty age- and sex-matched healthy children served as a control group. The diagnosis of MS was made according to the criteria adapted from the World Health Organization. They underwent clinical examination with causal blood pressure (BP) measurements, 24-hour ambulatory blood pressure monitoring (ABPM) and echocardiogram. Patients underwent echocardiography to detect left ventricular hypertrophy (LVH). LVMI was calculated as left ventricular mass/height^2.7.

Results

The mean age of MS group was 12.0?±?3.1 years. The mean value of LVMI was 46.5?±?11.5 g/m^2.7 in the MS group and it was significantly higher than those in the healthy children. The prevalence of severe LVH was 12 % using adult criteria (LVM?>?51 g/m^2.7) and 44 % using pediatric criteria (LVM?>?95th percentile). The mean daytime systolic BP load (β?=?0.315, p?=?0.003) and HOMA-IR (β?=?0.368, p?=?0.006) were found as the independent predictors of LVMI.

Conclusions

In conclusion, LVH occurs commonly in pediatric MS and is associated with systolic hypertension and insulin resistance. LVMI should be measured routinely for the predicting of cardiovascular risks in these patients.     

Live donor study – implications of kidney donation on cardiovascular risk with a focus on lipid parameters including lipoprotein a

In this prospective observational cohort study, we evaluate the change in cardiovascular risk parameters, with a focus on lipids, in live kidney donors 1 year post donation. Body mass index, systolic/diastolic blood pressure, kidney function (chromium‐51 ethylenediaminetetraacetic acid estimated glomerular filtration) and lipid parameters were measured at baseline and 1 year. Data on 87 live kidney donors were collected. Body mass index increased from 26.5 ± 2.7 pre to 27.4 ± 3.0 kg/m² post donation (p < 0.0001). Chromium‐51 ethylenediaminetetraacetic acid estimated glomerular filtration decreased from 111.8 ± 20.0 pre to 72.1 ± 13.1 mL/min/1.73 m² post donation (p < 0.0001). Serum triglyceride levels increased from 0.8 (interquartile range 0.6–1.3) pre to 1.0 mmol/L (interquartile range 0.7–1.6) post donation (p = 0.0004). Statin use increased from 11.5% pre to 21% post donation (p < 0.005). Low‐density lipoprotein remained stable, and other lipids (high‐density lipoprotein, apolipoprotein B and lipoprotein a) did not change post donation.