Left ventricular geometry and the risk of heavy coronary artery calcification in patients with pre-dialysis chronic kidney disease: the KoreaN Cohort Study for Outcome in Patients With Chronic Kidney Disease (KNOW-CKD)

The association between abnormal left ventricular geometry (LVG) patterns and the presence of coronary artery calcification is unclear in patients with CKD. A total of 2,038 patients with pre-dialysis CKD at stages 1 to 5 were categorized by LVG patterns, which were echocardiographically determined by the presence or absence of left ventricular hypertrophy (LVH) and relative wall thickness (RWT): normal, concentric remodeling, eccentric LVH, and concentric LVH. The study outcome was the presence of heavy coronary artery calcification, which is defined as coronary artery calcium score >1,000 Agatston units. Logistic regression analyses demonstrated that concentric remodeling (adjusted odds ratio [OR], 2.53; 95% confidence interval [95% CI], 1.32-4.85) and concentric LVH (adjusted OR, 2.89; 95% CI, 1.49-5.62), but not eccentric LVH (adjusted OR, 1.58; 95% CI, 0.71-3.51), were significantly associated with the risk of heavy coronary artery calcification. The presence of LVH alone was not significantly associated with the risk of heavy coronary artery calcification (adjusted OR, 1.65; 95% CI, 0.97-2.81), while the increase in RWT independently increased the risk of heavy coronary artery calcification (adjusted OR, 2.423; 95% CI, 1.48-4.00). Abnormal LVG patterns, such as concentric remodeling and concentric LVH, but not eccentric LVH, are significantly associated with the risk of heavy coronary artery calcification in patients with CKD. It is expected that the determination of LVG patterns may facilitate risk stratification in relation to the coronary evaluation strategy.