Background : Left ventricular hypertrophy(LVH) is the most frequent cardiac abnormality in patients with end-stage renal disease(ESRD). Calcification of aortic valve(AV) and increased arterial stiffness are also frequently found in hemodialysis patients. But whether LVH is associated with arterial stiffness and AV calcification in hemodialysis patients has not been well established. Subjects : We enrolled 112 subjects receiving the examinations of 2-dimensional echocardiography with Doppler and brachial ankle pulse wave velocity(baPWV) for assessment of arterial stiffness among hemodialysis patients. We examined LV mass index(LVMI) by M-mode, AV calcification, and LV diastolic indices(E/A ratio, deceleration time, DT, isovolumic relaxation time, IVRT) with tissue Doppler indices(E`, A`, S). We also measured baPWV with Colin VP-1000®. On the basis of LVMI with cut-off value of 125g/m2, we classified subjects into LVH and non-LVH groups. Results : Of 112 patients, 64 patients belonged to LVH group and 48 patients to non-LVH group. Two groups did not differ with regard to clinical factors except blood pressure. Systolic and diastolic blood pressures(BP) and pulse pressure(PP) were greater in LVH group than in non-LVH group. LVH group had greater baPWV as compared with non-LVH group (2179.3 ± 479.8 vs 1560.7 ± 307.5 cm/s, p<0.001). LVH group had lower ejection fraction (EF) (60.3 ± 8.5 vs 71.1 ±7.7%, p<0.001) and worse diastolic function than non-LVH group. The incidence of AV calcification was higher in LVH group (72 vs 12%). The LVMI was correlated positively with baPWV (r=0.32, p<0.05), systolic and diastolic BP(r=0.56, p<0.001 and r=0.37, p<0.005, respectively), PP (r=0.54, p<0.001), and AV calcification (r=0.56, p<0.001) and negatively with EF (r= -0.38, p<0.005) and E` (r= -0.34, p<005). A stepwise linear regression analysis showed that systolic BP, AV calcification, and baPWV were independently associated with LVH.
Conclusion : In ESRD patients treated with hemodialysis, LVH was associated with hypertension, increased arterial stiffness, AV calcification, and decreased LV systolic and diastolic function, suggesting that LVH in hemodialysis patients is a strong predictor of morbidity and mortality.
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