title: Relationship of left ventricular hypertrophy and diastolic function with cardiovascular and renal outcomes in African Americans with hypertensive chronic kidney disease.
abstract: African Americans with hypertension are at high risk for adverse outcomes from cardiovascular and renal disease. Patients with stage 3 or greater chronic kidney disease have a high prevalence of left ventricular (LV) hypertrophy and diastolic dysfunction. Our goal was to study prospectively the relationships of LV mass and diastolic function with subsequent cardiovascular and renal outcomes in the African American Study of Kidney Disease and Hypertension cohort study. Of 691 patients enrolled in the cohort, 578 had interpretable echocardiograms and complete relevant clinical data. Exposures were LV hypertrophy and diastolic parameters. Outcomes were cardiovascular events requiring hospitalization or causing death; a renal composite outcome of doubling of serum creatinine or end-stage renal disease (censoring death); and heart failure. We found strong independent relationships between LV hypertrophy and subsequent cardiovascular (hazard ratio, 1.16; 95% confidence interval, 1.05-1.27) events, but not renal outcomes. After adjustment for LV mass and clinical variables, lower systolic tissue Doppler velocities and diastolic parameters reflecting a less compliant LV (shorter deceleration time and abnormal E/A ratio) were significantly (P<0.05) associated with future heart failure events. This is the first study to show a strong relationship among LV hypertrophy, diastolic parameters, and adverse cardiac outcomes in African Americans with hypertension and chronic kidney disease. These echocardiographic risk factors may help identify high-risk patients with chronic kidney disease for aggressive therapeutic intervention.
authors.affiliation: Division of Cardiology, UT Southwestern, 5909 Harry Hines Blvd, Dallas, TX 75235-9047, USA. Gail.Peterson@UTSouthwestern.edu
authors.forename: Gail E
authors.initials: GE
authors.lastname: Peterson
authors.forename: Tine
authors.initials: T
authors.lastname: de Backer
authors.forename: Gabriel
authors.initials: G
authors.lastname: Contreras
authors.forename: Xuelei
authors.initials: X
authors.lastname: Wang
authors.forename: Cynthia
authors.initials: C
authors.lastname: Kendrick
authors.forename: Tom
authors.initials: T
authors.lastname: Greene
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Appel
authors.forename: Otelio S
authors.initials: OS
authors.lastname: Randall
authors.forename: Janice
authors.initials: J
authors.lastname: Lea
authors.forename: Miroslaw
authors.initials: M
authors.lastname: Smogorzewski
authors.forename: Tudor
authors.initials: T
authors.lastname: Vagaonescu
authors.forename: Robert A
authors.initials: RA
authors.lastname: Phillips
mesh_terms: D001741:Black or African American; D000368:Aged; D002318:Cardiovascular Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D015331:Cohort Studies; D003971:Diastole / Q000502:physiology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D017379:Hypertrophy, Left Ventricular / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D007668:Kidney / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D012307:Risk Factors; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology
keywords: African Americans; diastolic heart failure; echocardiography; hypertension; hypertrophy