WAVE REFLECTIONS AND CARDIAC-HYPERTROPHY IN CHRONIC UREMIA - INFLUENCE OF BODY-SIZE

Arterial wave reflections (AWRs), an important determinant of cardiac afterload, are increased in hemodialysis patients. However, an associa tion between AWRs and left ventricular hypertrophy has not been establ ished in these subjects. We therefore sought an association between th ese two parameters in a cross-sectional study of two outpatient hemodi alysis populations. AWRs were quantified (augmentation index, percent) as the ratio of the height of the late systolic peak to the total hei ght of the carotid pulse wave recorded with a micromanometer-tipped pr obe. AWRs were determined in 44 hemodialysis patients, 22 with pronoun ced AWRs (group A: augmentation index >12%), and 22 with small or mode rate AWRs (group B: augmentation index <12%). The groups were matched for age, sex, blood pressure, and hemodialysis duration. Left ventricu lar size was determined by echocardiography. Despite lower body size ( P<.005) and similar blood pressure, cardiac output, peripheral resista nce, and aortic pulse wave velocity, group A patients had greater left ventricular mass (P<.01). For the population as a whole, left ventric ular mass and AWRs were positively correlated (P<.0001) independent of age, blood pressure, hemodialysis duration, or body size. Lesser body height was the principal factor associated with increased AWRs in gro up A (P<.001). We conclude that in hemodialysis patients AWRs are asso ciated with the development of left ventricular hypertrophy and that s mall body height is a risk factor for long-term cardiovascular complic ations.