Cardiac magnetic resonance assessment of left ventricular mass in autosomal dominant polycystic kidney disease

Abstract

Background and objectives: Autosomal dominant polycystic kidney disease (ADPKD) is associated with a substantial cardiovascular disease burden including early onset hypertension, intracranial aneurysms, and left ventricular hypertrophy (LVH). A 41% prevalence of LVH has been reported in ADPKD, using echocardiographic assessment of LV mass (LVM). The HALT PKD study was designed to assess the effect of intensive angiotensin blockade on progression of total kidney volume and LVM. Measurements of LVM were performed using cardiac magnetic resonance (MR).

Design, setting, participants, & measurements: Five hundred forty-three hypertensive patients with GFR >60 ml/min per 1.73 m(2) underwent MR assessment of LVM at baseline. LVM was adjusted for body surface area and expressed as LVM index (LVMI; g/m(2)).

Results: Baseline BP was 125.1 ± 14.5/79.3 ± 11.6 mmHg. Average duration of hypertension was 5.79 years. Prior use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers was present in 59.5% of patients. The prevalence of LVH assessed using nonindexed LVM (g) was 3.9% (n = 21, eight men and 13 women) and 0.93% (n = 5, one man and four women) using LVMI (g/m(2)). In exploratory analyses, the prevalence of LVH using LVM indexed to H(2.7), and the allometric index ppLVmass(HW), ranged from 0.74% to 2.23% (n = 4 to 12). Multivariate regression showed significant direct associations of LVMI with systolic BP, serum creatinine, and albuminuria; significant inverse associations with LVMI were found with age and female gender.

Conclusions: The prevalence of LVH in hypertensive ADPKD patients <50 years of age with short duration of hypertension, and prior use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers is low. Early BP intervention in ADPKD may have decreased LVH and may potentially decrease cardiovascular mortality.

Figure 1.

Magnetic resonance image of the heart. Image in short axis at the mid left ventricular level at end diastole demonstrating (A) before and (B) after the delineation of epicardial and endocardial borders, and (C) segmented left ventricular area.

Figure 2.

Frequency distribution of left ventricular mass (LVM) for men and women. (A) Frequency distribution of nonindexed LVM for men and women. The upper limit of normal for LVM in men is 203.5 g, shown as solid line. The upper limit of normal for LVM in women is 140.3, shown as dashed line. (B) Frequency distribution of LVMI for men and women. The upper limit of normal for LVMI in men is 106.2 g/m², shown as solid line. The upper limit of normal for LVMI in women is 84.6 g/m², shown as dashed line.