Associations of Conventional Echocardiographic Measures with Incident Heart Failure and Mortality: The Chronic Renal Insufficiency Cohort
Year: 2016
Type: article
Study design: Observational Study
Abstract: Background and objectives Heart failure is the most frequent cardiac complication of CKD. Left ventricular hypertrophy is common and develops early in CKD, but studies have not adequately evaluated the association of left ventricular mass index with heart failure incidence among men and women with CKD. Design, setting, participants, & measurements We evaluated echocardiograms of 2567 participants without self–reported heart failure enrolled in the Chronic Renal Insufficiency Cohort Study. Two-dimensional echocardiograms were performed at the year 1 study visit and interpreted at a central core laboratory. Left ventricular mass index was calculated using the linear method, indexed to height 2.7 , and analyzed using sex-specific quartiles. The primary outcomes of incident heart failure and all-cause mortality were adjudicated over a median of 6.6 (interquartile range, 5.7–7.6) years. Results Among 2567 participants, 45% were women, and 54% were nonwhite race; mean (SD) age was 59±11 years old, and mean eGFR was 44±17 ml/min per 1.73 m 2 . During a median follow-up period of 6.6 years, 262 participants developed heart failure, and 470 participants died. Compared with participants in the first quartile of left ventricular mass index, those in the highest quartile had higher rates of incident heart failure (hazard ratio, 3.96; 95% confidence interval, 1.96 to 8.02) and mortality (hazard ratio, 1.86; 95% confidence interval, 1.22 to 2.85), even after adjustment for B–type natriuretic peptide, troponin T, mineral metabolism markers, and other cardiovascular disease risk factors. Those in the lowest quartile of ejection fraction had higher rates of incident heart failure (hazard ratio, 3.01; 95% confidence interval, 1.94 to 4.67) but similar mortality rates (hazard ratio, 1.18; 95% confidence interval, 0.89 to 1.57) compared with those in the highest quartile. Diastolic dysfunction was not significantly associated with heart failure or death. Conclusions Among persons with CKD and without history of cardiovascular disease, left ventricular mass index is strongly associated with incident heart failure, even after adjustment for major cardiovascular risk factors and biomarkers.
DOI: 10.2215/cjn.02700316
Authors: Ruth F. Dubin, Rajat Deo, Nisha Bansal, Amanda H. Anderson, Peter Yang, Alan S. Go, Martin Keane, Ray Townsend, Anna Porter, Matthew Budoff, Shaista Malik, Jiang He, Mahboob Rahman, Jackson Wright, Thomas Cappola, Radhakrishna Kallem, Jason Roy, Daohang Sha, Michael G. Shlipak, the CRIC Study Investigators
Institutions: San Francisco VA Medical Center, University of California, San Francisco, University of Pennsylvania, University of Washington, Kaiser Permanente, Kaiser Permanente Oakland Medical Center, Temple University Hospital, University of California, Irvine, University of California, Los Angeles, Tulane University, University Hospitals Cleveland Medical Center
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
Awards: Clinical and Translational Science Institute, Heart failure and atrial arrhythmias in CKD, Heart Failure Incidence and Progression in Renal Disease, Continuation of the Chronic Renal Insufficiency Cohort (CRIC) Study, SBHW-PREDICT (The role of PRoteomics, gEnetics, and Directed Imaging using CT), Kidney Tubular Damage and Dysfunction Identify a Novel Axis of Chronic Kidney Disease, General Clinical Research Center, Translational Research in Hypertension and Renal Biology, Novel Echocardiographic Methods to Characterize Heart Failure in ESRD, Elucidating Pathways of Vascular Dysfunction and Myocardial Injury in ESRD, Center for Clinical and Translational Science, Michigan Institute for Clinical and Health Research (MCHR), Institute for Clinical and Translational Research, Institutional Clinical and Translational Science Award, Clinical and Translational Science Collaborative of Cleveland, A pilot trial of an intervention to support initial type 2 diabetes selfmanagement among younger adults with children., Prospective renal insufficiency cohort evaluation: PRICE, Chronic Renal Insufficiency Cohort (CRIC) Study Clinical Center, Institutional Clinical and Translational Science Award, Continuation of the University of Illinois Chicago CRIC Clinical Center, Limited Competition for the Continuation of the Chronic Renal Insufficiency Cohort (CRIC) Hopkins Clinical Center, Tulane Clinical Center for Chronic Renal Insufficiency Cohort Study, Chronic Renal Insufficiency Cohort Limited competition continuation, Chronic Renal Insufficiency Cohort (CRIC) Study
OpenAlex ID: W2550024672