Abstract
Purpose
Left ventricular hypertrophy (LVH) is a well-known risk factor for poor clinical outcomes in patients undergoing dialysis. However, little evidence supports the above notion in Japan, and the influence of subtypes of LVH on prognosis.
Methods
We investigated 367 patients undergoing dialysis who underwent routine echocardiographic examinations between April and September 2018. LVH was defined as any LV mass ≥ 115 g/m2 in men and ≥ 95 g/m2 in women obtained by echocardiography. The primary endpoint was a composite outcome including all-cause death, admission due to heart failure, and ischemic heart event or stroke. LVH was divided into subtype-groups according to eccentric hypertrophy or concentric hypertrophy, and with and without hypertension.
Results
LVH was observed in 171 (47%) patients. The primary endpoint was observed in 58 patients (16%) during the median follow-up period of 500 days. Multivariable Cox regression analyses identified four independent risk factors for the primary endpoint: age, pulse rate, serum albumin level, and LV mass index (per 10-g/m2 increase; hazard ratio: 1.12, 95% confidence interval: 1.06–1.18, P < 0.001). Kaplan–Meier analyses demonstrated that patients with LVH had a worse prognosis than those without LVH in terms of the primary endpoint (log-rank P < 0.001). The incidence of the primary outcome was not significantly different between patients with eccentric or concentric hypertrophy, and between LVH patients with and without hypertension.
Conclusion
Japanese patients with LVH undergoing dialysis had a worse prognosis than those without LVH in terms of the composite clinical endpoint.
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Acknowledgements
We would like to express our thanks to the patients who participated in this study and their families. We also thank Emi Hanai and all the clinical technologists and sonographers who performed the echocardiography, and all the doctors who managed the dialysis at Masuko Memorial Hospital.
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This study was not supported by any grants.
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Yoshihiro Seo is a member of Journal of Medical Ultrasonics’ editorial team. The other authors declare no conflicts of interest associated with this study.
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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent was obtained from all patients for being included in the study (The information in this retrospective study is available on the Masuko Memorial Hospital website, and all patients are given the opportunity to withdraw from the study).
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10396_2022_1197_MOESM5_ESM.tif
Supplementary file5 Figure S1. Survival curves for all-cause death according to the primary disease of diabetes mellitus and non-diabetes mellitus. Overall mortality was significantly higher among patients whose primary disease was diabetes mellitus compared to those with the primary disease of non-diabetes mellitus (TIF 104 KB)
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Nakayama, T., Yamamoto, J., Ozeki, T. et al. Impact of left ventricular hypertrophy on clinical outcomes in patients with dialysis: a single-center study in Japan. J Med Ultrasonics 49, 241–252 (2022). https://doi.org/10.1007/s10396-022-01197-4
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DOI: https://doi.org/10.1007/s10396-022-01197-4