Effect of the geometry and severity of left ventricular hypertrophy on cardiovascular mortality in patients on chronic hemodialysis

Abstract Background Left ventricular hypertrophy (LVH) is a vital risk factor for mortality in patients on dialysis. The association of the geometry and severity of LVH with cardiovascular mortality and mortality in patients on hemodialysis (HD) remains unknown. This study investigated clinical outcomes among patients on HD with different LVH geometric patterns and severity. Methods Patients on chronic HD from a single medical center who underwent echocardiography for the assessment of LVH geometric patterns and severity were enrolled. They were divided into concentric and eccentric groups and then subdivided into four groups based on LVH severity: mild-to-moderate eccentric LVH, mild-to-moderate concentric LVH, severe eccentric LVH, and severe concentric LVH. The risks of all-cause mortality and cardiovascular mortality between groups were evaluated using Cox proportional hazard analysis. Results Of the 237 enrolled patients on HD with LVH, 131 had concentric LVH, and 106 had eccentric LVH, with 33, 44, 73, and 87 having mild-to-moderate eccentric LVH, mild-to-moderate concentric LVH, severe eccentric LVH, and severe concentric LVH, respectively. Compared with eccentric LVH, the crude HR of mortality and cardiovascular mortality of concentric LVH was 1.60 (0.96–2.66) and 2.03 (1.13–3.65). Severe concentric LVH was a significant risk factor for all-cause mortality and cardiovascular mortality compared with mild-to-moderate eccentric LVH (crude HR: 2.58, 95% CI: 1.00–6.65 and 3.73, 1.13–12.33, respectively). After adjustment for all variables, concentric LVH and severe concentric LVH remained significant risk factors for cardiovascular mortality (adjusted HR: 2.13, 95% CI: 1.13–4.01 and 3.71, 1.07–12.82, respectively). Conclusions Concentric LVH, especially severe concentric LVH, was associated with a high risk of cardiovascular mortality among patients on chronic HD.