Key result
Increased left ventricular mass is a significant predictor of subsequent kidney dysfunction, with each 42 g/m² increase in left ventricular mass index raising the risk of doubling serum creatinine by 45.7% in men with high cardiovascular risk.
Why the study?
The prognostic importance of left ventricular hypertrophy on renal impairment in patients with high cardiovascular risk had not been addressed previously.
Cohort (n=6,163)
Effect estimate: 45.7% increase in risk (95% CI 28.5-58.3)
p-value: p=<0.001
Supports renal monitoring in high-risk men with elevated LVMI; extends associations but remains hypothesis-generating and should not change practice.
OBJECTIVE: The prognostic importance of left ventricular hypertrophy (LVH) on renal impairment has not been addressed previously. We investigated whether LVH determines renal outcomes in patients with high cardiovascular risk. METHODS: We retrospectively studied 6163 men with high cardiovascular risk (68 ± 13 years, 23% with coronary artery disease, 34% with diabetes, 83% with hypertension and 30% smokers) followed for a period of 14 years. Left ventricular mass index was assessed at baseline, whereas kidney function and blood pressure levels were determined at both baseline and the end of the follow-up period. Renal outcomes were doubling of serum creatinine, estimated glomerular filtration rate (eGFR) below 30 ml/min per 1.73 m and incident hemodialysis. RESULTS: During the follow-up, 5.8% (n = 356), 7% (n = 429) and 2.7% (n = 165) of men fulfilled the above-mentioned three outcomes, respectively. After adjustment, for each 42 g/m (1 SD) increase in left ventricular mass index, there was a rise in risk of all renal outcomes by 45.7% (95% confidence interval 28.5-58.3) for doubling of serum creatinine, 51.9% (95% confidence interval 39.7-65%) for eGFR below 30 ml/min per 1.73 m and 58.3% (95% confidence interval 39.7-79.3) for hemodialysis (P < 0.001 for all). Severe LVH (160 < left ventricular mass index ≤ 180 g/m) compared with non-LVH predicted a significant increase in: doubling of serum creatinine by 103.8%, eGFR-guided outcome by 109.1% and hemodialysis by 74.1%. In those with LVH and impaired kidney function at baseline (GFR <60 ml/min per 1.73 m) compared with those without such entities, serum creatinine, eGFR and hemodialysis-guided outcomes were increased by four-fold, 15-fold and 16-fold, respectively. CONCLUSION: Increased left ventricular mass is a predictor of subsequent kidney dysfunction and should be considered in renal risk stratification in a broad spectrum of men with high cardiovascular risk.
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Tsioufis et al. (2010) conducted a cohort in High cardiovascular risk (n=6,163). Left ventricular hypertrophy (increase in left ventricular mass index) vs. No left ventricular hypertrophy / lower left ventricular mass index was evaluated on Doubling of serum creatinine (per 1 SD / 42 g/m² increase in left ventricular mass index) (45.7% increase in risk, 95% CI 28.5-58.3, p=<0.001). Increased left ventricular mass is a significant predictor of subsequent kidney dysfunction, with each 42 g/m² increase in left ventricular mass index raising the risk of doubling serum creatinine by 45.7% in men with high cardiovascular risk.
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