Left ventricular geometry and cardiovascular mortality based on haemodialysis patient autopsy analyses.
OBJECTIVE
In end-stage renal disease (ESRD) patients, left ventricular hypertrophy (LVH) is common and a risk for cardiovascular events. LVH is geometrically classified into two major groups, concentric and eccentric, and accumulating evidence suggests eccentric LVH has a more negative effect than concentric LVH on ESRD outcome. However, there have been very few studies on the cardiac findings from ESRD patient autopsy in which the relationship between LVH geometry and mortality was analyzed.


METHODS
An observational study was performed with the autopsy findings in 30 haemodialysis patient cases between 2001 and 2006 at Mitsui Memorial Hospital, Tokyo. Between those who died of a cardiovascular cause and those who died of non-cardiovascular causes, we compared the heart/bodyweight ratio, left ventricular dilatation, and the extent of fibrosis of the left ventricle.


RESULTS
Heart/bodyweight ratio was significantly higher (P < 0.0001) in the cardiovascular mortality group (n = 11, 11.7 +/- 2.5 g/kg) compared to the non-cardiac cause of death group (n = 19, 8.05 +/- 0.7 g/kg). The dilatation of the left ventricle was significantly more frequent in the cardiovascular than the non-cardiac cause of death group (P = 0.016). Additionally, the fibrotic area of left ventricular cross-section was larger in the cardiovascular (1.63 +/- 1.6%) than the non-cardiac group (0.83 +/- 1.7%, P = 0.04).


CONCLUSIONS
This autopsy study indicates that eccentric LVH in haemodialysis patients is closely associated with cardiovascular mortality. LVH geometry, as well as LVH severity, is worthy of consideration as a clinical predictor for cardiovascular mortality.
Mimura
Imari
I
Division of Nephrology and Endocrinology, University of Tokyo School of Medicine, Tokyo, Japan.
Nishi
Hiroshi
H
Mise
Naobumi
N
Mori
Masaya
M
Sugimoto
Tokuichiro
T
D000368:Aged; D001344:Autopsy; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality* / Q000473:pathology; D002423:Cause of Death; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D005260:Female; D005355:Fibrosis; D006352:Heart Ventricles / Q000473:pathology*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000209:etiology / Q000401:mortality / Q000473:pathology*; D007564:Japan; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality / Q000628:therapy*; D008297:Male; D006435:Renal Dialysis / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index