SYMMETRICAL AND ASYMMETRIC LEFT-VENTRICULAR HYPERTROPHY IN PATIENTS WITH END-STAGE RENAL-FAILURE ON LONG-TERM HEMODIALYSIS

Background: Patients with end-stage renal disease on regular hemodialy sis have an increased prevalence of left ventricular (LV) hypertrophy that is associated with morbidity and mortality. Asymmetric septal hyp ertrophy and impairment of LV outflow can occur in these patients and may contribute to adverse outcomes. More insight into the prevalence, extent, geometry, and promoting factors of LV hypertrophy is important . Methods: An unselected group of 62 patients (31 women), aged 55 +/- 14 years, on maintenance hemodialysis was investigated by Doppler echo cardiography. Eight patients with valvular heart disease were excluded from further analysis. We assessed prevalence of LV hypertrophy and a symmetric septal hypertrophy, as well as parameters of LV geometry and LV filling and outflow dynamics. Results: Prevalence of LV hypertroph y was 65%. Patients were analyzed according to LV mass and geometry. M ean LV mass index was normal (105 +/- 17 g/m(2)) in Group 1 without LV hypertrophy (n = 19); it was markedly elevated in Group 2 (symmetric hypertrophy, n = 22) and Group 3 (asymmetric hypertrophy with systolic anterior movement of mitral valve, n = 7), and highest (191 +/- 54 g/ m(2)) in Group 4 (asymmetric hypertrophy without systolic anterior mov ement of mitral valve, n = 6, p < 0.001). Age, body mass index, and du ration of hypertension were associated with LV hypertrophy and asymmet ric septal hypertrophy (p = 0.01). Group 3 with systolic anterior moti on of mitral valve had the smallest end-diastolic LV diameters (p = 0. 02); increased heart rates, and increased ejection velocities in the L V outflow tract (p = 0.03, and p = 0.005, respectively, vs. Groups 1, 2, and 4) which pointed to an impairment of LV outflow. Conclusions: S ymmetric LV hypertrophy and asymmetric septal hypertrophy are frequent in patients on maintenance hemodialysis. Predictors for LV hypertroph y were age and body mass index, and, particularly for asymmetric septa l hypertrophy, age and hypertension duration. Volume withdrawal during hemodialysis may lead to symptomatic hypotension due to dynamic obstr uction in some patients with severe asymmetric septal hypertrophy.