Left ventricular hypertrophy in mild and moderate reduction in kidney function determined using cardiac magnetic resonance imaging and cystatin C: the multi-ethnic study of atherosclerosis (MESA).
BACKGROUND
Left ventricular (LV) hypertrophy (LVH) is associated with chronic kidney disease, but the association of LVH with a mild decrease in kidney function is not known. We hypothesized that mild and moderate decreases in kidney function, reflected in greater serum cystatin C concentrations, would be linearly associated with a greater prevalence of LVH.


METHODS
Cross-sectional observational study.


METHODS
Participants in baseline examinations in the Multi-Ethnic Study of Atherosclerosis (MESA), a population-based study with several sites in the United States.


METHODS
Cystatin C-based estimated glomerular filtration rate (eGFR(cysC)) and creatinine-based eGFR.


RESULTS
LVH and LV mass index.


METHODS
Serum cystatin C and creatinine, LV mass obtained by using magnetic resonance imaging. LVH cutoff values for men and women were defined by the upper 95th percentile of LV mass index of all MESA participants without hypertension.


RESULTS
Of the 4,971 participants analyzed, mean creatinine-based eGFR was 81 +/- 17 (SD) mL/min/1.73 m(2) and mean eGFR(cysC) was 94 +/- 32 mL/min/1.73 m(2). LVH was distinctly more prevalent (>12%) in only the lowest 2 deciles of eGFR(cysC) (<75 mL/min/1.73 m(2)). When 435 participants (9%) with stage 3 or higher chronic kidney disease (creatinine-based eGFR < 60 mL/min/1.73 m(2)) were excluded, the odds for LVH increased for each lower category of eGFR(cysC) less than 75 mL/min/1.73 m(2): odds ratio 1.6 for LVH with eGFR(cysC) of 60 to 75 mL/min/1.73 m(2) (95% confidence interval, 1.20 to 2.07; P = 0.001), and odds ratio 2.0 for eGFR(cysC) less than 60 mL/min/1.73 m(2) (95% confidence interval, 1.03 to 3.75; P = 0.04) after adjustment for demographic factors, study site, diabetes, and smoking. The association of lower eGFR(cysC) with LVH was attenuated after further adjustment for hypertension.


CONCLUSIONS
Cross-sectional rather than longitudinal design, lack of participants with more advanced kidney disease, lack of a direct measurement of glomerular filtration rate.


CONCLUSIONS
In participants without chronic kidney disease, eGFR(cysC) of 75 mL/min/1.73 m(2) or less was associated with a greater odds of LVH.
Division of General Internal Medicine, Department of Medicine, Columbia University, New York, NY, USA.
Andrew
A
Moran
Ronit
R
Katz
Nancy Swords
NS
Jenny
Brad
B
Astor
David A
DA
Bluemke
João A C
JA
Lima
David
D
Siscovick
Alain G
AG
Bertoni
Michael G
MG
Shlipak
D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People; D003430:Cross-Sectional Studies; D055316:Cystatin C; D015891:Cystatins / Q000097:blood*; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000097:blood* / Q000150:complications / Q000175:diagnosis*; D007674:Kidney Diseases / Q000097:blood* / Q000150:complications / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D044465:White People
C525030:CST3 protein, human; D055316:Cystatin C; D015891:Cystatins