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Determinants of Left Ventricular Mass and Hypertrophy in Hemodialysis Patients Assessed by Cardiac Magnetic Resonance Imaging

Rajan K. Patel^*,, Scott Oliver, Patrick B. Mark^*,, Joanna R. Powell^*,, Emily P. McQuarrie^*,, James P. Traynor, Henry J. Dargie, and Alan G. Jardine^*,

^* BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom;
Departments of Renal Medicine and
Cardiology, Western Infirmary, Glasgow, Scotland, United Kingdom; and
Renal Unit, Monklands General Hospital, Airdrie, Scotland, United Kingdom

Correspondence: Dr. Rajan K. Patel, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK. Phone: +44-141-330-2705; Fax: +44-141-330-6972; E-mail: r.patel{at}clinmed.gla.ac.uk

Background and objectives: Left ventricular hypertrophy (LVH) is an independent risk factor for premature cardiovascular death in hemodialysis (HD) patients and one of the three forms of uremic cardiomyopathy. Cardiovascular magnetic resonance (CMR) is a volume-independent technique to assess cardiac structure. We used CMR to assess the determinants of left ventricular mass (LVM) and LVH in HD patients.

Design, setting, participants, & measurements: A total of 246 HD patients (63.8% male; mean age 51.5 ± 12.1 yr) underwent CMR on a postdialysis day. LVM was measured from a stack of cine loops and indexed for body surface area (LVM index [LVMI]). Demographic, past biochemical, hematologic, and dialysis data were collected by patient record review. Results up to 180 d before CMR were collected. LVH was defined as LVMI >84.1 g/m² (male) or >76.4 g/m² (female).

Results: A total of 157 (63.8%) patients had LVH. LVH was more common in patients with higher predialysis systolic BP, predialysis pulse pressure, and calcium-phosphate product (Ca x PO₄). Furthermore, LVH was significantly associated with higher end-diastolic and systolic volumes and lower ejection fraction. There were positive correlations with LVMI and end-diastolic and systolic volumes. There were weak positive correlations among LVMI, mean volume of ultrafiltration, and Ca x PO₄. Using multivariate linear and logistic regression (entering one BP and cardiac variable), the independent predictors of LVMI and LVH were end-diastolic volume, predialysis systolic BP, and Ca x PO₄.

Conclusions: The principal determinants of LVM and LVH in HD patients are end-diastolic LV volume, predialysis BP, and Ca x PO₄.