title: Associations of Left Ventricular Hypertrophy and Geometry with Adverse Outcomes in Patients with CKD and Hypertension.
abstract: OBJECTIVE
  Left ventricular hypertrophy (LVH) and abnormal left ventricular (LV) geometry predict adverse outcomes in the general and hypertensive populations, but findings in CKD are still inconclusive.
  
  
  METHODS
  We enrolled 445 patients with hypertension and CKD stages 2-5 in two academic nephrology clinics in 1999-2003 who underwent both echocardiography and ambulatory BP monitoring. LVH (LV mass >100 g/m(2) [women] and >131 g/m(2) [men]) and relative wall thickness (RWT) were used to define LV geometry: no LVH and RWT≤0.45 (normal), no LVH and RWT>0.45 (remodeling), LVH and RWT≤0.45 (eccentric), and LVH and RWT>0.45 (concentric). We evaluated the prognostic role of LVH and LV geometry on cardiovascular (CV; composite of fatal and nonfatal events) and renal outcomes (composite of ESRD and all-cause death).
  
  
  RESULTS
  Age was 64.1±13.8 years old; 19% had diabetes, and 22% had CV disease. eGFR was 39.9±20.2 ml/min per 1.73 m(2). LVH was detected in 249 patients (56.0%); of these, 125 had concentric LVH, and 124 had eccentric pattern, whereas 71 patients had concentric remodeling. Age, women, anemia, and nocturnal hypertension were independently associated with both concentric and eccentric LVH, whereas diabetes and history of CV disease associated with eccentric LVH only, and CKD stages 4 and 5 associated with concentric LVH only. During follow-up (median, 5.9 years; range, 0.04-15.3), 188 renal deaths (112 ESRD) and 103 CV events (61 fatal) occurred. Using multivariable Cox analysis, concentric and eccentric LVH was associated with higher risk of CV outcomes (hazard ratio [HR], 2.59; 95% confidence interval [95% CI], 1.39 to 4.84 and HR, 2.79; 95% CI, 1.47 to 5.26, respectively). Similarly, greater risk of renal end point was detected in concentric (HR, 2.33; 95% CI, 1.44 to 3.80) and eccentric (HR, 2.30; 95% CI, 1.42 to 3.74) LVH. Sensitivity analysis using LVH and RWT separately showed that LVH but not RWT was associated with higher cardiorenal risk.
  
  
  CONCLUSIONS
  In patients with CKD, LVH is a strong predictor of the risk of poor CV and renal outcomes independent from LV geometry.
authors.affiliation: Division of Nephrology, Dialysis and Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) University Hospital San Martino-Istituto Nazionale per la Ricerca sul Cancro (IST), University of Genoa, Genoa, Italy;
authors.forename: Ernesto
authors.initials: E
authors.lastname: Paoletti
authors.affiliation: Division of Nephrology and.
authors.forename: Luca
authors.initials: L
authors.lastname: De Nicola
authors.affiliation: Department of Medicine, Veterans Affairs San Diego Healthcare System and University of California at San Diego Medical School, San Diego, California;
authors.forename: Francis B
authors.initials: FB
authors.lastname: Gabbai
authors.affiliation: Department of Medicine and Public Health, Second University of Naples, Naples, Italy;
authors.forename: Paolo
authors.initials: P
authors.lastname: Chiodini
authors.affiliation: Division of Nephrology, Dialysis and Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) University Hospital San Martino-Istituto Nazionale per la Ricerca sul Cancro (IST), University of Genoa, Genoa, Italy;
authors.forename: Maura
authors.initials: M
authors.lastname: Ravera
authors.affiliation: Division of Nephrology, Dialysis and Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) University Hospital San Martino-Istituto Nazionale per la Ricerca sul Cancro (IST), University of Genoa, Genoa, Italy;
authors.forename: Laura
authors.initials: L
authors.lastname: Pieracci
authors.affiliation: Division of Nephrology, Dialysis and Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) University Hospital San Martino-Istituto Nazionale per la Ricerca sul Cancro (IST), University of Genoa, Genoa, Italy;
authors.forename: Sonia
authors.initials: S
authors.lastname: Marre
authors.affiliation: Division of Cardiology, IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genoa, Italy;
authors.forename: Paolo
authors.initials: P
authors.lastname: Cassottana
authors.affiliation: Division of Cardiology, Santa Maria del Popolo degli Incurabili Hospital (PO SMdP Incurabili), Local Healthcare Unit Napoli1 Centro, Naples, Italy; and.
authors.forename: Sergio
authors.initials: S
authors.lastname: Lucà
authors.affiliation: Unit of Nephrology-Dialysis, Urology and Renal Transplantation, Fondazione IRCCS Ca' Grande Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Vettoretti
authors.affiliation: Division of Nephrology and.
authors.forename: Silvio
authors.initials: S
authors.lastname: Borrelli
authors.affiliation: Division of Nephrology and.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Conte
authors.affiliation: Division of Nephrology and roberto.minutolo@unina2.it.
authors.forename: Roberto
authors.initials: R
authors.lastname: Minutolo
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D016009:Chi-Square Distribution; D018450:Disease Progression; D004452:Echocardiography; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D007558:Italy / Q000453:epidemiology; D007668:Kidney / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D015995:Prevalence; D016016:Proportional Hazards Models; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D020257:Ventricular Remodeling
keywords: blood pressure monitoring, ambulatory; chronic kidney disease; echocardiography; female; follow-up studies; humans; hypertension; hypertrophy, left ventricular; left ventricular geometry