Why the study?
Adults with chronic kidney disease are at increased risk for heart failure, but longitudinal cardiac remodeling has not been well-characterized and its association with heart failure outcomes remains unknown.
Does adverse longitudinal cardiac remodeling (changes in echocardiographic parameters) increase the risk of heart failure hospitalization and death in adults with chronic kidney disease?
Does adverse longitudinal cardiac remodeling (changes in echocardiographic parameters) increase the risk of heart failure hospitalization and death in adults with chronic kidney disease?
In adults with chronic kidney disease, adverse longitudinal cardiac remodeling over a 4-year period is independently associated with an increased risk of subsequent heart failure hospitalization and mortality.
Serial echo changes may flag higher HF risk in CKD but should not yet change practice; leaves open whether targeting remodeling improves outcomes.
Adults with chronic kidney disease (CKD) are at increased risk for developing heart failure (HF). However, longitudinal cardiac remodeling in CKD has not been well-characterized and its association with HF outcomes remains unknown. We evaluated the association between change in echocardiographic parameters between baseline and year 4 with the subsequent risk of HF hospitalization and death using Cox proportional hazard models in a landmark analysis of a prospective multicenter CKD cohort. Among 2673 participants, mean ± SD age was 61 ± 11 years, with 45% women, and 56% non-white. A total of 472 hospitalizations for HF and 776 deaths occurred during a median (interquartile range) follow-up duration of 8.0 (6.3-9.1) years. Patients hospitalized for HF experienced larger preceding absolute increases in left ventricular (LV) volumes and decreases in LV ejection fraction. Adverse changes in LV ejection fraction, LV cavity volume, LV mass index, and LV geometry were independently associated with an increased risk of HF hospitalization and death. Among adults with CKD, deleterious cardiac remodeling occurs over a relatively short timeframe and adverse remodeling is associated with increased risk of HF-related morbidity and mortality.
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Fitzpatrick et al. (2023) studied this question.
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