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. 2014 Jul;25(7):1599-608.
doi: 10.1681/ASN.2013080899. Epub 2014 Feb 13.

Longitudinal changes of cardiac structure and function in CKD (CASCADE study)

Qi-Zhe Cai  1 , Xiu-Zhang Lu  2 , Ye Lu  3 , Angela Yee-Moon Wang  4
Affiliations

Longitudinal changes of cardiac structure and function in CKD (CASCADE study)

Qi-Zhe Cai et al. J Am Soc Nephrol. 2014 Jul.

Abstract

Little is known regarding the natural longitudinal changes in cardiac structure and function in CKD. We hypothesized that baseline CKD stage is associated with progressive worsening in cardiac structure and function. We conducted a prospective longitudinal study, recruiting 300 patients with stages 3-5 CKD from a major regional tertiary center and university teaching hospital in Hong Kong. Baseline CKD stages were studied in relation to natural longitudinal changes in echocardiographic and tissue Doppler imaging-derived parameters. Over 1 year, the prevalence of left ventricular (LV) hypertrophy increased from 40.3% to 48.9%, median left atrial volume index increased 4.8 (interquartile range [IQR], 2.1, 7.7) ml/m(2) (P<0.001), peak systolic mitral annular velocity decreased 0.5 (IQR, -1.5, 0.5) cm/s (P<0.001), early diastolic mitral annular velocity decreased 0.5 (IQR, -1.5, 0.5) cm/s (P<0.001), and eGFR declined 2.0 (IQR, -5.0, 0.0) ml/min per 1.73 m(2). CKD stages 4 and 5 were associated with more baseline abnormalities in cardiac structure and function and predicted greater longitudinal progression in LV mass index (odds ratio [OR], 3.02; 95% confidence interval [95% CI], 1.39 to 6.58), volume index (OR, 2.58; 95% CI, 1.18 to 5.62), and left atrial volume index (OR, 2.61; 95% CI, 1.20 to 5.69) and worse diastolic dysfunction grade (OR, 3.17; 95% CI, 1.16 to 8.69) compared with stage 3a in the fully adjusted analysis. In conclusion, more advanced CKD at baseline may be associated with larger longitudinal increases in LV mass and volume and greater deterioration in diastolic function.

Keywords: chronic kidney disease; echocardiography; heart disease; left ventricular hypertrophy.

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Figures

Figure 1.
Figure 1.
(A) Increased prevalence of LV hypertrophy over 1 year. (B) Increased prevalence and severity of diastolic dysfunction over 1 year. (C) More advanced CKD showed more decline in eGFR over 1 year. (D) More advanced CKD showed greater increase in prevalence of LV hypertrophy and more deterioration in LV geometric pattern over 1 year. (E) More advanced CKD showed greater increase in prevalence and severity of diastolic dysfunction over 1 year. Diastolic function was graded according to the recommendation by the American Society of Echocardiography as normal, grades I (mild), II (moderate), and III (severe) diastolic dysfunction. Diastolic function was not graded in 10 patients with atrial fibrillation at baseline and in an additional 5 patients with new-onset atrial fibrillation at 1 year.
Figure 1.
Figure 1.
(A) Increased prevalence of LV hypertrophy over 1 year. (B) Increased prevalence and severity of diastolic dysfunction over 1 year. (C) More advanced CKD showed more decline in eGFR over 1 year. (D) More advanced CKD showed greater increase in prevalence of LV hypertrophy and more deterioration in LV geometric pattern over 1 year. (E) More advanced CKD showed greater increase in prevalence and severity of diastolic dysfunction over 1 year. Diastolic function was graded according to the recommendation by the American Society of Echocardiography as normal, grades I (mild), II (moderate), and III (severe) diastolic dysfunction. Diastolic function was not graded in 10 patients with atrial fibrillation at baseline and in an additional 5 patients with new-onset atrial fibrillation at 1 year.
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