Abstract 4039: Preclinical Cardiac Disease and Outcome in Adults with Kidney Disease: The Strong Heart Study
Background: We have shown that preclinical cardiac abnormalities are associated with reduced glomerular filtration rate (GFR) in a population-based sample of middle-aged and elderly adults. However, the independent prognostic impact of these cardiac abnormalities remains to be clarified in adults with kidney disease (KD).
Methods: We analyzed the relations of LV structure, function and risk factors to fatal and non-fatal cardiovascular (CV) events during mean follow-up of 7 years in 2,039 American Indian Strong Heart Study (SHS) participants with Stage 2–5 KD (GFR=0 to <90 ml/min/1.73m2). LV mass/height2.7>49.2 (men) or >46.7 g/m2.7 (women) was considered LV hypertrophy, stress-corrected midwall shortening<88.7% as midwall dysfunction and E/A ratio<0.6 and >1.5 as impaired LV relaxation and restrictive LV filling, respectively.
Results: Of 2,039 SHS participants with KD (61% female, mean age=61±8 years, mean BMI=1±6 kg/m2), 576 (28%) had LV hypertrophy, 248 (12%) had midwall dysfunction and 136 (6%) had impaired relaxation and 65 (3%) had restrictive LV filling. CV events were higher in those with LV hypertrophy compared to those without (43 vs. 22%, p<0.001). Similarly, CV events were more common among those with than without midwall dysfunction (55 vs. 24%, p<0.001). Those with impaired LV relaxation or restrictive LV filling also had higher CV events (48 and 45 vs. 26%, p<0.001). Cox-proportional hazards models adjusting for age, sex, BMI, systolic BP, LDL and HDL cholesterol, hypertension treatment, diabetes mellitus, current smoking and creatinine clearance revealed that LV hypertrophy (HR=1.73, 95% CI=1.39–2.15), midwall dysfunction (HR=1.98, 95% CI=1.57–2.52 [both p<.001]), impaired LV relaxation (HR=2.26, 95% CI=1.43–3.59, p=0.001) and restrictive LV filling (RR=1.34, 95% CI=1.07–1.67, p=0.005) were independently associated with CV events.
Conclusion: In a population-based sample of adults with KD, LV hypertrophy, midwall dysfunction and impaired relaxation and restrictive LV filling at baseline echocardiog-raphy were associated with 1.3 to 2.3-fold increased fatal and nonfatal CV events independently of conventional risk factors including creatinine clearance.