Left Ventricular Hypertrophy Is a Risk Factor Independent of Hypertension in Survival of Hemodialyzed Patients

Abstract

Hemodialysis patients have low 5-year survival rates of approximately 60%, and the most common cause of death is cardiovascular diseases. Their population may be considered, therefore, as an accelerated model in analyzing the risk factors for cardiovascular diseases. We previously reported the role of blood pressure, one of the most important risk factors for cardiovascular diseases, in determining the prognosis of hemodialysis patients. In this study, we examined the effect of cardiomegaly detected on chest roentgenogram or electrocardiogram before initiating hemodialysis therapy on survival after introduction to maintenance hemodialysis. One hundred and sixty hemodialysis patients who had no history of ischemic heart disease or arrhythmia were followed up for 88.9 +/- 4.0 months, among whom 69 died. Heart enlargement, defined on chest roentgenogram, was detected in 104 patients, and left ventricular hypertrophy, defined on electrocardiogram, was detected in 105 patients. The presence of either finding shortened their survival. However, Cox's proportional hazards model and logistic multiple regression analysis identified only left ventricular hypertrophy as one of the significant determinants for survival, but heart enlargement was not independent. Correction of systolic hypertension on the maintenance phase had no significant favorable effect on survival in patients with left ventricular hypertrophy, while it improved in those with heart enlargement. This finding, together with those above from Cox's model and logistic analysis strongly suggests that risk from left ventricular hypertrophy is independent of, but one from heart enlargement is dependent on hypertension.

Electrocardiography and Outcome in Patients with Diabetes Mellitus on Maintenance Hemodialysis

“…With respect to total mortality and CVE, we found a significant association in the univariate, but not in the multivariate, analyses. This is partly consistent with earlier findings but does not comply with data mainly derived from echocardiographic studies showing a clear association between LVH and mortality in hemodialysis populations (19)(20)(21)(22)(23). This might be due to the fact that the sensitivity of hypertrophy markers in the ECG is low (24,25).…”

Predictors of cardiovascular events in patients with end-stage renal disease: an analysis from the Fosinopril in Dialysis study

“…In contrast, other studies that have reported LVH as a prognostic marker had a prevalence of LVH ranging from 65% to 75% [6][7][8]10]. The relative risk of CVE in this analysis was more than 60% higher for patients with the largest LVMI (>180) as compared with those who had a lesser degree of LVH.…”

“…These studies differ from FOSIDIAL in that the timing of LV mass measurement was remote from study enrolment (1 year) [6], whereas LV mass was measured within 3 months of randomization in the FOSIDIAL study. Other studies measured LVH by electrocardiogram [8]. These factors and other differences in study populations may account for the greater risk associated with LV mass in our study.…”

“…LVH has been associated with CVE in patients with ESRD [6,8]. These studies differ from FOSIDIAL in that the timing of LV mass measurement was remote from study enrolment (1 year) [6], whereas LV mass was measured within 3 months of randomization in the FOSIDIAL study.…”

“…As a result, little is known about the nature of CVE that occur in these patients. Several factors such as C-reactive protein (CRP) and left ventricular hypertrophy (LVH) have been shown in other studies to predict all-cause mortality, but factors that specifically predict CVE have been less widely evaluated [5][6][7][8][9][10]. Additionally, the strength of these factors to specifically predict CVE when considered together in a multivariate model has not been fully explored.…”