Impact of Definitions of Left Ventricular Hypertrophy on Left Ventricular Remodeling Findings in Patients with Predialysis Chronic Kidney Disease: An Echocardiographic Study

Background: The impact of different definitions of left ventricular hypertrophy (LVH) on the assessment of left ventricular (LV) remodeling in predialysis chronic kidney disease (CKD) remains unclear. Methods: Echocardiography was performed on 107 consecutively enrolled patients with different stages of CKD including 36 patients mild CKD (CKD stages 1 and 2) and 71 patients with moderate/severe CKD (CKD stages 3, 4, and 5). LVH was defined by the following three sets of sex-specific criteria: left ventricular mass (LVM) indexed to body surface area; LVM indexed to height; and LVM indexed to height(2.7). Results: In the mild CKD group, LVM indexed to height(2.7) detected 14 in 15 LVH patients; however, LVM indexed to BSA and height detected 9 and 7 patients, respectively. In the moderate/severe CKD group, LVM indexed to height(2.7) detected 42 in 43 LVH patients; however, LVM indexed to BSA and height both detected 29 patients. In the moderate/severe CKD group, patients with LVH who fulfilled all three criteria at the same time had lower Em and Am and higher mitral E/Em and isovolumic relaxation time (IVRT) than those patients without LVH. Among patients without LVH, moderate/severe CKD patients had significantly higher mitral E/Em and longer IVRT than in mild CKD. In multivariable regression analysis, the independent predictors of septal E/Em > 15 were CKD severity (odds ratio = 3.16, 95% confidence interval = 1.64-6.08, p = 0.001) and LVH indexed by height(2.7) (odds ratio = 4.10, 95% confidence interval = 1.27-13.32, p = 0.019). Conclusion: LVH indexed by height(2.7) could detect most of the LVH in predialysis CKD patients.