title: Eccentric Left Ventricular Hypertrophy and Sudden Death in Patients with End-Stage Kidney Disease.
abstract: OBJECTIVE
  Both all-cause and cardiovascular mortality risks are extremely high in patients with end-stage kidney disease (ESKD). Sudden death accounts for approximately one-quarter of all fatal events. Left ventricular hypertrophy (LVH) is a known risk factor for mortality and can be divided in 2 types: concentric and eccentric. This study evaluated possible differences in all-cause mortality, cardiovascular mortality and sudden death between prevalent ESKD patients with concentric and eccentric LVH.
  
  
  METHODS
  Participants of the CONvective TRAnsport STudy (CONTRAST) who underwent transthoracic echocardiography (TTE) at baseline were analyzed. In patients with LVH, a relative wall thickness of ≤0.42 was considered eccentric and >0.42 was considered concentric hypertrophy. Cox proportional hazards models, adjusted for potential confounders, were used to calculate hazard ratios (HRs) of patients with eccentric LVH versus patients with concentric LVH for all-cause mortality, cardiovascular mortality and sudden death.
  
  
  RESULTS
  TTE was performed in 328 CONTRAST participants. LVH was present in 233 participants (71%), of which 87 (37%) had concentric LVH and 146 (63%) eccentric LVH. The HR for all-cause mortality of eccentric versus concentric LVH was 1.14 (p = 0.52), 1.79 (p = 0.12) for cardiovascular mortality and 4.23 (p = 0.02) for sudden death in crude analyses. Propensity score-corrected HR for sudden death in patients with eccentric LVH versus those with concentric LVH was 5.22 (p = 0.03).
  
  
  CONCLUSIONS
  (1) The hazard for all-cause mortality, cardiovascular mortality and sudden death is markedly increased in patients with LVH. (2) The sudden death risk is significantly higher in ESKD patients with eccentric LVH compared to subjects with concentric LVH.
authors.affiliation: Department of Nephrology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Camiel L M
authors.initials: CL
authors.lastname: de Roij van Zuijdewijn
authors.forename: Romy
authors.initials: R
authors.lastname: Hansildaar
authors.forename: Michiel L
authors.initials: ML
authors.lastname: Bots
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Blankestijn
authors.forename: Marinus A
authors.initials: MA
authors.lastname: van den Dorpel
authors.forename: Muriel P C
authors.initials: MP
authors.lastname: Grooteman
authors.forename: Otto
authors.initials: O
authors.lastname: Kamp
authors.forename: Piet M
authors.initials: PM
authors.lastname: ter Wee
authors.forename: Menso J
authors.initials: MJ
authors.lastname: Nubé
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality*; D003645:Death, Sudden / Q000453:epidemiology*; D004452:Echocardiography; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000453:epidemiology*; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D016016:Proportional Hazards Models; D006435:Renal Dialysis; D012307:Risk Factors; D020257:Ventricular Remodeling