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Left ventricular hypertrophy in mild and moderate reduction in kidney function determined using cardiac magnetic resonance imaging and cystatin C: the multi-ethnic study of atherosclerosis (MESA).

ABSTRACT: BACKGROUND:Left ventricular (LV) hypertrophy (LVH) is associated with chronic kidney disease, but the association of LVH with a mild decrease in kidney function is not known. We hypothesized that mild and moderate decreases in kidney function, reflected in greater serum cystatin C concentrations, would be linearly associated with a greater prevalence of LVH. STUDY DESIGN:Cross-sectional observational study. SETTINGS & PARTICIPANTS:Participants in baseline examinations in the Multi-Ethnic Study of Atherosclerosis (MESA), a population-based study with several sites in the United States. PREDICTORS:Cystatin C-based estimated glomerular filtration rate (eGFR(cysC)) and creatinine-based eGFR. OUTCOMES:LVH and LV mass index. MEASUREMENTS:Serum cystatin C and creatinine, LV mass obtained by using magnetic resonance imaging. LVH cutoff values for men and women were defined by the upper 95th percentile of LV mass index of all MESA participants without hypertension. RESULTS:Of the 4,971 participants analyzed, mean creatinine-based eGFR was 81 +/- 17 (SD) mL/min/1.73 m(2) and mean eGFR(cysC) was 94 +/- 32 mL/min/1.73 m(2). LVH was distinctly more prevalent (>12%) in only the lowest 2 deciles of eGFR(cysC) (<75 mL/min/1.73 m(2)). When 435 participants (9%) with stage 3 or higher chronic kidney disease (creatinine-based eGFR < 60 mL/min/1.73 m(2)) were excluded, the odds for LVH increased for each lower category of eGFR(cysC) less than 75 mL/min/1.73 m(2): odds ratio 1.6 for LVH with eGFR(cysC) of 60 to 75 mL/min/1.73 m(2) (95% confidence interval, 1.20 to 2.07; P = 0.001), and odds ratio 2.0 for eGFR(cysC) less than 60 mL/min/1.73 m(2) (95% confidence interval, 1.03 to 3.75; P = 0.04) after adjustment for demographic factors, study site, diabetes, and smoking. The association of lower eGFR(cysC) with LVH was attenuated after further adjustment for hypertension. LIMITATIONS:Cross-sectional rather than longitudinal design, lack of participants with more advanced kidney disease, lack of a direct measurement of glomerular filtration rate. CONCLUSIONS:In participants without chronic kidney disease, eGFR(cysC) of 75 mL/min/1.73 m(2) or less was associated with a greater odds of LVH.

SUBMITTER: Moran A

PROVIDER: S-EPMC2597288 | biostudies-literature | 2008 Nov

REPOSITORIES: biostudies-literature

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Left ventricular hypertrophy in mild and moderate reduction in kidney function determined using cardiac magnetic resonance imaging and cystatin C: the multi-ethnic study of atherosclerosis (MESA).

Moran Andrew A Katz Ronit R Jenny Nancy Swords NS Astor Brad B Bluemke David A DA Lima João A C JA Siscovick David D Bertoni Alain G AG Shlipak Michael G MG

American journal of kidney diseases : the official journal of the National Kidney Foundation 20081008 5

<h4>Background</h4>Left ventricular (LV) hypertrophy (LVH) is associated with chronic kidney disease, but the association of LVH with a mild decrease in kidney function is not known. We hypothesized that mild and moderate decreases in kidney function, reflected in greater serum cystatin C concentrations, would be linearly associated with a greater prevalence of LVH.<h4>Study design</h4>Cross-sectional observational study.<h4>Settings & participants</h4>Participants in baseline examinations in th ...[more]

PMID: 18845370

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Project description:Background Few data exist on the long-term risk prediction of elevated left ventricular (LV) mass quantified by MRI for cardiovascular (CV) events in a contemporary, ethnically diverse cohort. Purpose To assess the long-term impact of elevated LV mass on CV events in a prospective cohort study of a multiethnic population in relationship to risk factors and coronary artery calcium (CAC) score. Materials and Methods The Multi-Ethnic Study of Atherosclerosis, or MESA (ClinicalTrials.gov: NCT00005487), is an ongoing prospective multicenter population-based study in the United States. A total of 6814 participants (age range, 45-84 years) free of clinical CV disease at baseline were enrolled between 2000 and 2002. In 4988 participants (2613 [52.4%] women; mean age, 62 years ± 10.1 [standard deviation]) followed over 15 years for CV events, LV mass was derived from cardiac MRI at baseline enrollment by using semiautomated software at a central core laboratory. Cox proportional hazard models, Kaplan-Meier curves, and z scores were applied to assess the impact of LV hypertrophy. Results A total of 290 participants had hard coronary heart disease (CHD) events (207 myocardial infarctions [MIs], 95 CHD deaths), 57 had other CV disease-related deaths, and 215 had heart failure (HF). LV hypertrophy was an independent predictor of hard CHD events (hazard ratio [HR]: 2.7; 95% confidence interval [CI]: 1.9, 3.8), MI (HR: 2.8; 95% CI: 1.8, 4.0), CHD death (HR: 4.3; 95% CI: 2.5, 7.3), other CV death (HR: 7.5; 95% CI: 4.2, 13.5), and HF (HR: 5.4; 95% CI: 3.8, 7.5) (P < .001 for all end points). LV hypertrophy was a stronger predictor than CAC for CHD death, other CV death, and HF (z scores: 5.4 vs 3.4, 6.8 vs 2.4, and 9.7 vs 3.2 for LV hypertrophy vs CAC, respectively). Kaplan-Meier analysis demonstrated an increased risk of CV events in participants with LV hypertrophy, particularly after 5 years. Conclusion Elevated left ventricular mass was strongly associated with hard coronary heart disease events, other cardiovascular death, and heart failure over 15 years of follow-up, independent of traditional risk factors and coronary artery calcium score. © RSNA, 2019 See also the editorial by Hanneman in this issue.

Dataset Information

Left ventricular hypertrophy in mild and moderate reduction in kidney function determined using cardiac magnetic resonance imaging and cystatin C: the multi-ethnic study of atherosclerosis (MESA).

Publications

Left ventricular hypertrophy in mild and moderate reduction in kidney function determined using cardiac magnetic resonance imaging and cystatin C: the multi-ethnic study of atherosclerosis (MESA).

Similar Datasets

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