Left ventricular hypertrophy in mild and moderate reduction in kidney function determined using cardiac magnetic resonance imaging and cystatin C: the multi-ethnic study of atherosclerosis (MESA)

Abstract

Background: Left ventricular (LV) hypertrophy (LVH) is associated with chronic kidney disease, but the association of LVH with a mild decrease in kidney function is not known. We hypothesized that mild and moderate decreases in kidney function, reflected in greater serum cystatin C concentrations, would be linearly associated with a greater prevalence of LVH.

Study design: Cross-sectional observational study.

Settings & participants: Participants in baseline examinations in the Multi-Ethnic Study of Atherosclerosis (MESA), a population-based study with several sites in the United States.

Predictors: Cystatin C-based estimated glomerular filtration rate (eGFR(cysC)) and creatinine-based eGFR.

Outcomes: LVH and LV mass index.

Measurements: Serum cystatin C and creatinine, LV mass obtained by using magnetic resonance imaging. LVH cutoff values for men and women were defined by the upper 95th percentile of LV mass index of all MESA participants without hypertension.

Results: Of the 4,971 participants analyzed, mean creatinine-based eGFR was 81 +/- 17 (SD) mL/min/1.73 m(2) and mean eGFR(cysC) was 94 +/- 32 mL/min/1.73 m(2). LVH was distinctly more prevalent (>12%) in only the lowest 2 deciles of eGFR(cysC) (<75 mL/min/1.73 m(2)). When 435 participants (9%) with stage 3 or higher chronic kidney disease (creatinine-based eGFR < 60 mL/min/1.73 m(2)) were excluded, the odds for LVH increased for each lower category of eGFR(cysC) less than 75 mL/min/1.73 m(2): odds ratio 1.6 for LVH with eGFR(cysC) of 60 to 75 mL/min/1.73 m(2) (95% confidence interval, 1.20 to 2.07; P = 0.001), and odds ratio 2.0 for eGFR(cysC) less than 60 mL/min/1.73 m(2) (95% confidence interval, 1.03 to 3.75; P = 0.04) after adjustment for demographic factors, study site, diabetes, and smoking. The association of lower eGFR(cysC) with LVH was attenuated after further adjustment for hypertension.

Limitations: Cross-sectional rather than longitudinal design, lack of participants with more advanced kidney disease, lack of a direct measurement of glomerular filtration rate.

Conclusions: In participants without chronic kidney disease, eGFR(cysC) of 75 mL/min/1.73 m(2) or less was associated with a greater odds of LVH.

Trial registration: ClinicalTrials.gov NCT00005487.

Figures

Figure 1

Figure 1a. Percent left ventricular hypertrophy (LVH) by decile of cystatin C-based estimated glomerular filtration rate (eGFRcysC, ml/min/1.73 m2) in 4,971 MESA participants. (LVH cut points for MESA were 107.8 g/m2 in males, and 85.3 g/m2 in females). Figure 1b. Mean left ventricular (LV) mass index (g/m2 body surface area) by deciles of cystatin C-based estimated glomerular filtration rate (eGFRcysC, ml/min/1.73 m2) in 4,971 MESA participants.

Figure 1

Figure 1a. Percent left ventricular hypertrophy (LVH) by decile of cystatin C-based estimated glomerular filtration rate (eGFRcysC, ml/min/1.73 m2) in 4,971 MESA participants. (LVH cut points for MESA were 107.8 g/m2 in males, and 85.3 g/m2 in females). Figure 1b. Mean left ventricular (LV) mass index (g/m2 body surface area) by deciles of cystatin C-based estimated glomerular filtration rate (eGFRcysC, ml/min/1.73 m2) in 4,971 MESA participants.