title: Associations of Conventional Echocardiographic Measures with Incident Heart Failure and Mortality: The Chronic Renal Insufficiency Cohort.
abstract: Heart failure is the most frequent cardiac complication of CKD. Left ventricular hypertrophy is common and develops early in CKD, but studies have not adequately evaluated the association of left ventricular mass index with heart failure incidence among men and women with CKD.
  
  
  
  We evaluated echocardiograms of 2567 participants without self-reported heart failure enrolled in the Chronic Renal Insufficiency Cohort Study. Two-dimensional echocardiograms were performed at the year 1 study visit and interpreted at a central core laboratory. Left ventricular mass index was calculated using the linear method, indexed to height2.7, and analyzed using sex-specific quartiles. The primary outcomes of incident heart failure and all-cause mortality were adjudicated over a median of 6.6 (interquartile range, 5.7-7.6) years.
  
  
  
  Among 2567 participants, 45% were women, and 54% were nonwhite race; mean (SD) age was 59±11 years old, and mean eGFR was 44±17 ml/min per 1.73 m2. During a median follow-up period of 6.6 years, 262 participants developed heart failure, and 470 participants died. Compared with participants in the first quartile of left ventricular mass index, those in the highest quartile had higher rates of incident heart failure (hazard ratio, 3.96; 95% confidence interval, 1.96 to 8.02) and mortality (hazard ratio, 1.86; 95% confidence interval, 1.22 to 2.85), even after adjustment for B-type natriuretic peptide, troponin T, mineral metabolism markers, and other cardiovascular disease risk factors. Those in the lowest quartile of ejection fraction had higher rates of incident heart failure (hazard ratio, 3.01; 95% confidence interval, 1.94 to 4.67) but similar mortality rates (hazard ratio, 1.18; 95% confidence interval, 0.89 to 1.57) compared with those in the highest quartile. Diastolic dysfunction was not significantly associated with heart failure or death.
  
  
  
  Among persons with CKD and without history of cardiovascular disease, left ventricular mass index is strongly associated with incident heart failure, even after adjustment for major cardiovascular risk factors and biomarkers.
authors.affiliation: University of California, San Francisco/San Francisco Veterans Affairs Medical Center, San Francisco, California.
authors.forename: Ruth F
authors.initials: RF
authors.lastname: Dubin
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Rajat
authors.initials: R
authors.lastname: Deo
authors.affiliation: University of Washington, Seattle, Washington.
authors.forename: Nisha
authors.initials: N
authors.lastname: Bansal
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Amanda H
authors.initials: AH
authors.lastname: Anderson
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Peter
authors.initials: P
authors.lastname: Yang
authors.affiliation: Division of Clinical Research, Kaiser Permanente, Oakland, California.
authors.forename: Alan S
authors.initials: AS
authors.lastname: Go
authors.affiliation: Temple University Hospital, Philadelphia, Pennsylvania.
authors.forename: Martin
authors.initials: M
authors.lastname: Keane
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Ray
authors.initials: R
authors.lastname: Townsend
authors.affiliation: University of California, Irvine, California.
authors.forename: Anna
authors.initials: A
authors.lastname: Porter
authors.affiliation: University of California, Los Angeles, California.
authors.forename: Matthew
authors.initials: M
authors.lastname: Budoff
authors.affiliation: Temple University Hospital, Philadelphia, Pennsylvania.
authors.forename: Shaista
authors.initials: S
authors.lastname: Malik
authors.affiliation: Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; and.
authors.forename: Jiang
authors.initials: J
authors.lastname: He
authors.affiliation: University Hospitals Case Medical Center, Cleveland, Ohio.
authors.forename: Mahboob
authors.initials: M
authors.lastname: Rahman
authors.affiliation: University Hospitals Case Medical Center, Cleveland, Ohio.
authors.forename: Jackson
authors.initials: J
authors.lastname: Wright
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Thomas
authors.initials: T
authors.lastname: Cappola
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Radhakrishna
authors.initials: R
authors.lastname: Kallem
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Jason
authors.initials: J
authors.lastname: Roy
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Daohang
authors.initials: D
authors.lastname: Sha
authors.affiliation: University of California, San Francisco/San Francisco Veterans Affairs Medical Center, San Francisco, California.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Shlipak
mesh_terms: D000368:Aged; D002423:Cause of Death; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology* / Q000503:physiopathology; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology*; D013318:Stroke Volume
keywords: Biomarkers; Cardiovascular Diseases; Female; Follow-Up Studies; Humans; Hypertrophy, Left Ventricular; Incidence; Male; Minerals; Renal Insufficiency, Chronic; Troponin T; chronic kidney disease; echocardiography; epidemiology; heart failure; renal insufficiency, chronic; risk factors