DETERMINANTS OF LEFT-VENTRICULAR HYPERTROPHY AND SYSTOLIC DYSFUNCTIONIN CHRONIC-RENAL-FAILURE

To evaluate determinants of left ventricular hypertrophy (LVH) and lef t ventricular (LV) systolic dysfunction in chronic renal failure (CRF) , M-mode and two-dimensional echocardiography were performed in 38 und ialyzed patients with CRF (serum creatinine greater than or equal to 3 .4 mg/dL), 54 patients receiving continuous ambulatory peritoneal dial ysis, 30 patients receiving hemodialysis, and 59 healthy age- and sex- matched volunteers. Left ventricular (LV) wall thickness and LV dimens ions were greatest in dialysis patients, intermediate in CRF patients, and least in control subjects. LV mass index calculated from M-mode m easurements was 78.7 g/m(2) +/- 14.8 g/m(2) in controls, 120.5 g/ m(2) +/- 28.7 g/m(2) in CRF patients, and 138 +/- 45.0 g/m(2) in dialysis patients (P < 0.0001). LV fractional shortening and LV velocity of cir cumferential shortening were lower in dialysis patients than in CRF pa tients and controls (fractional shortening 36.5% +/- 5.6% in controls, 36.2% +/- 7.2% in CRF patients, and 29.8% +/- 8.9% in dialysis patien ts; P < 0.0001). Echocardiography was normal in only 24 dialysis patie nts (29%) and 14 CRF patients (37%) (P = NS). Thirty-nine dialysis pat ients (46%) and 10 CRF patients (26%) had LVH (P = NS). Thirty dialysi s patients (36%) and five CRF patients (13%) had LV systolic dysfuncti on (P < 0.05). LV hypertrophy with LV systolic dysfunction was present in 15 dialysis patients but no CRF patients (P < 0.05). There were no significant differences between hemodialysis patients and continuous ambulatory peritoneal dialysis patients in M-mode echocardiographic me asurements or the frequency of LVH and LV systolic dysfunction. Using multiple regression analysis, LV wall thickness was positively correla ted with systolic blood pressure (P < 0.001, r(2) = 10.3%), where r(2) is the variance explained independent of other variables. LV mass ind ex was positively correlated with diastolic blood pressure (P < 0.05, r(2) = 6.7%) and inversely correlated with hematocrit (P < 0.01, r(2) = 8.1%). Logistic regression analysis showed that LVH was positively c orrelated with systolic blood pressure (P < 0.005) and diabetic nephro pathy (P < 0.005). LV systolic dysfunction was positively correlated w ith age (P < 0.01). No relationship between secondary hyperparathyroid ism and cardiac disease was found. Conclusions: LV hypertrophy and LV systolic dysfunction occur frequently in both peritoneal dialysis pati ents and hemodialysis patients. LV hypertrophy is also common in undia lyzed patients with moderate to severe CRF, but systolic function is u sually preserved in these patients. The strongest independent predicto rs of LVH in this study were hypertension, diabetes, and anemia. Age w as the strongest independent predictor of LV systolic dysfunction. Add itional laboratory and prospective clinical studies are needed to furt her elucidate the mechanisms involved in the development of LVH and LV impairment in renal failure, and undialyzed patients with moderate or severe CRF should be included in such studies, as cardiac disease is frequently established prior to dialysis. (C) 1994 by the National Kid ney Foundation, Inc.