THE PROGNOSTIC IMPORTANCE OF LEFT-VENTRICULAR GEOMETRY IN UREMIC CARDIOMYOPATHY

The objective of this study was to determine the effect of left ventri cular (LV) mass, volume, and mass-to-volume ratio on mortality in chro nic dialysis patients. The Design was a multicenter, prospective incep tion cohort study with a median fellow-up of 41 months. The Setting wa s three university-affiliated nephrology units. A total of 433 patient s who (1) survived >6 months from the start of ESRD therapy and (2) ha d a technically satisfactory baseline echocardiogram were studied. Mea surements included a baseline clinical, laboratory and echocardiograph ic assessment. LV hypertrophy was present in 74% and LV dilation was p resent in 36% of patients. In patients with normal cavity volume (less than or equal to 90 mL/m(2)) and normal systolic function, high LV ma ss index (>120 g/m(2)) and mass-to-volume ratios (>2.2 g/mL) were inde pendently associated with late mortality (>2 yr after starting dialysi s therapy), After adjusting for baseline age, diabetes, and ischemic h eart disease, the relative risk for the former was 3.29 and for the la tter was 2.24. Cavity volume was of no prognostic significance in this group. In patients with IV dilation and normal systolic function, hig h cavity volume (>120 mL/m(2)) and low mass-to-volume ratio (<1.8 mL/m (2)) were independently associated with late mortality, the relative r isk in the former being 17.14 and the latter being 4.27. LV mass index was of no prognostic significance in this group. The baseline echocar diographic classification, based on LV mass and cavity volume, was the strongest predictor of late mortality, after adjusting for age, gende r, diabetes mellitus, coronary artery disease, angina pectoris, chroni c hypertension, and hemoglobin and serum albumin levels. Although both LV mass and volume are predictors of later mortality in dialysis pati ents, their prognostic effects are dissociated: mass is associated wit h mortality only in patients with normal cavity volume, whereas volume is associated with mortality only in patients with cavity dilation. I n both groups, the ratio of LV mass-to-volume appears to be of prognos tic significance, but in diametrically opposite directions. LV geometr y has a major effect on prognosis in ESRD patients.