Renal Insufficiency Increases the Combined Risk of Left Ventricular Hypertrophy and Dysfunction in Patients at High Risk of Cardiovascular Diseases

Abstract

Background: The identification of asymptomatic structural and functional cardiac abnormalities can help us to recognize early and intervene in patients at pre-heart failure (HF). However, few studies have adequately evaluated the associations of renal function and left ventricular (LV) structure and function in patients at high risk of cardiovascular diseases (CVD). Methods: Patients undergoing coronary angiography and/or percutaneous coronary interventions were enrolled from the Cardiorenal ImprovemeNt II (CIN-II) cohort study, and their echocardiography and renal function were assessed at admission. Patients were divided into five groups according to their estimated glomerular filtration rate (eGFR). Our outcomes were LV hypertrophy and LV systolic and diastolic dysfunction. Multivariable logistic regression analyses were conducted to investigate the associations of eGFR with LV hypertrophy and LV systolic and diastolic dysfunction. Results: A total of 5610 patients (mean age: 61.6 ± 10.6 years; 27.3% female) were included in the final analysis. The prevalence of LV hypertrophy assessed by echocardiography was 29.0%, 34.8%, 51.9%, 66.7%, and 74.3% for the eGFR categories >90, 61–90, 31–60, 16–30, and ≤15 mL/min per 1.73 m2 or for patients needing dialysis, respectively. Multivariate logistic regression analysis showed that subjects with eGFR levels of ≤15 mL/min per 1.73 m2 or needing dialysis (OR: 4.66, 95% CI: 2.96–7.54), as well as those with eGFR levels of 16–30 (OR: 3.87, 95% CI: 2.43–6.24), 31–60 (OR: 2.00, 95% CI: 1.64–2.45), and 61–90 (OR: 1.23, 95% CI: 1.07–1.42), were significantly associated with LV hypertrophy. This reduction in renal function was also significantly associated with LV systolic and diastolic dysfunction (all P for trend <0.001). In addition, a per one unit decrease in eGFR was associated with a 2% heightened combined risk of LV hypertrophy and systolic and diastolic dysfunction. Conclusions: Among patients at high risk of CVD, poor renal function was strongly associated with cardiac structural and functional abnormalities. In addition, the presence or absence of CAD did not change the associations. The results may have implications for the pathophysiology behind cardiorenal syndrome.

Nomogram‐based risk assessment model for left ventricular hypertrophy in patients with essential hypertension: Incorporating clinical characteristics and biomarkers

“…Renal function is associated with LVH. Prior studies 18 have suggested that the prevalence of LVH negatively correlates with eGFR in patients at a high risk of cardiovascular disease, and each unit decrease in eGFR is associated with a 2% heightened combined risk of LVH. The prevalence of LVH assessed by echocardiography ranges from 29% to 74.3% in the different stages of renal insufficiency 27 .…”

“…For example, the prevalence of LVH is approximately 3% in individuals with normal blood pressure, while in untreated hypertensive patients it rises to between 19% and 48%, with the prevalence of LVH in high‐risk hypertensive patients being as high as 58%–77% 10–12 . Some clinical characteristics are inconsistent in the literature, including blood pressure level, age, obesity, gender, the severity of hypertension, dietary salt intake, 13–15 and renal insufficiency 16–18 . These inconsistencies could be attributed to observational biases and random errors stemming from small sample sizes in single‐center trials.…”

“… 10 , 11 , 12 Some clinical characteristics are inconsistent in the literature, including blood pressure level, age, obesity, gender, the severity of hypertension, dietary salt intake, 13 , 14 , 15 and renal insufficiency. 16 , 17 , 18 These inconsistencies could be attributed to observational biases and random errors stemming from small sample sizes in single‐center trials. Consequently, a large‐scale, multicenter study would be instrumental in clarifying the associated risk factors for LVH in EH patients.…”

Assessing medication levels in patients and investigating the connection between sports participation and cardiovascular disease (CVD): A systematic review with clinical implications

“…In subgroup analyses that accounted for the potential associations between conditions such as diabetes status, high BP, high cholesterol, previous heart attacks, short-term heart attacks and valvular heart left ventricular hypertrophy, the relationship between physical activity or cardiovascular fitness and heart failure remained. Complications such as age, education, BMI, family history of CVD, and the use of nicotine and alcohol were considered in these investigations (Lu et al 2023). A lower risk of heart failure has been linked to higher levels of overall physical activity, which includes walking and cycling combined, intense exercise, leisure-time activity, industrial activity, and cardiorespiratory fitness (Ketels et al 2020).…”

Rates, predictors, and causes of readmission after transcatheter aortic valve replacement in patients with chronic kidney disease

“…Common comorbidities reported among women include pulmonary hypertension, hypertension, diabetes, and anemia[ 17 ]. Proposed mechanisms in the setting of AS include a higher incidence of concentric hypertrophy than men, diastolic dysfunction, and reduced preload and stroke volume[ 20 - 22 ].…”