Associations of Traditionally Determined Left Ventricular Mass Indices and Hemodynamic and Non-Hemodynamic Components of Cardiac Remodeling with Diastolic and Systolic Function in Patients with Chronic Kidney Disease

Abstract

We aimed to evaluate the extent to which different left ventricular mass parameters are associated with left ventricular function in chronic kidney disease (CKD) patients. We compared the associations between traditionally determined left ventricular mass indices (LVMIs) and hemodynamic (predicted LVMIs) and non-hemodynamic remodeling parameters with left ventricular function in patients with CKD; non-hemodynamic remodeling was represented by inappropriate left ventricular mass and inappropriate excess LVMIs (traditionally determined LVMIs-predicted LVMIs). Non-hemodynamic left ventricular remodeling parameters were strongly associated with impaired left ventricular systolic function (p < 0.001), whereas hemodynamic left ventricular remodeling was also related strongly (p < 0.001) but directly to left ventricular systolic function. Independent of one another, hemodynamic and non-hemodynamic left ventricular remodeling had associations in opposite directions to left ventricular systolic function and was associated directly with traditionally determined left ventricular mas indices (p < 0.001 for all relationships). Non-hemodynamic cardiac remodeling parameters discriminated more effectively than traditionally determined LVMIs between patients with and without reduced ejection fraction (p < 0.04 for comparison). Left ventricular mass parameters were unrelated to impaired diastolic function in patients with CKD. Traditionally determined LVMIs are less strongly associated with impaired systolic function than non-hemodynamic remodeling parameters (p < 0.04-0.01 for comparisons) because they represent both adaptive or compensatory and non-hemodynamic cardiac remodeling.

Keywords: chronic kidney disease; diastolic–systolic function; hemodynamic; non-hemodynamic cardiac remodeling components; traditionally determined left ventricular mass index.

Figure 1

Associations between LVMI-BSA (A) or LVMI-ht^1.7 (B) and ejection fraction both in base model and after adjusting for iLVM and inappropriate excess and predicted left ventricular mass indices. ILVM, inappropriate left ventricular mass; log, logarithmically transformed, i.e., inappropriate excess; LVMI-BSA, left ventricular mass indexed to body surface area; LVMI-ht^1.7, left ventricular mass index indexed to height^1.7.

Figure 2

Receiver operator characteristic curves showing performance of LVMI–BSA (A), LVMI-ht^1.7 (B), inappropriate LVM (C) and inappropriate excess LVMI-BSA (D) and LVMI-ht^1.7 (E) in identifying patients with reduced ejection fraction (<50%). AUC, area under the curve; LVMI-BSA, left ventricular mass indexed to body surface area; LVM-ht^1.7, left ventricular mass indexed to height^1.7; LVM, left ventricular mass.