Left Ventricular Geometry and Inferior Vena Cava Diameter Co-Modify the Risk of Cardiovascular Outcomes in Chronic Hemodialysis Patients

Chung-Kuan Wu; Ming Wang; Zih-Kai Kao; Noi Yar; Ming-Tsang Chuang; Tzu-Hao Chang

doi:10.3390/medicina60071140

Left Ventricular Geometry and Inferior Vena Cava Diameter Co-Modify the Risk of Cardiovascular Outcomes in Chronic Hemodialysis Patients

Medicina (Kaunas). 2024 Jul 15;60(7):1140. doi: 10.3390/medicina60071140.

Authors

Chung-Kuan Wu^{1

2}, Ming Wang¹, Zih-Kai Kao³, Noi Yar¹, Ming-Tsang Chuang⁴, Tzu-Hao Chang^{5

6}

Affiliations

¹ Division of Nephrology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan.
² School of Medicine, Fu-Jen Catholic University, New Taipei 242, Taiwan.
³ Institute of Biophotonics, National Yang Ming Chiao Tung University, Taipei 112, Taiwan.
⁴ Clinical Data Center, Office of Data Science, Taipei Medical University, Taipei 11031, Taiwan.
⁵ Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei 11031, Taiwan.
⁶ Clinical Big Data Research Center, Taipei Medical University, Taipei 11031, Taiwan.

Abstract

Background and Objectives: Left ventricular hypertrophy (LVH) represents a significant cardiovascular risk in patients undergoing chronic hemodialysis (CHD). A large inferior vena cava diameter (IVCD), potentially indicative of fluid overload and a contributing factor to elevated cardiovascular risk, has not been sufficiently explored. Therefore, our study aims to gain further insights into this aspect. Materials and Methods: A retrospective cohort study enrolled patients receiving CHD in a single medical center with available echocardiography from October to December 2018. They were categorized into four groups based on LVH geometry and IVCD. Cox proportional hazard models assessed the risk of major adverse cardiovascular effects (MACEs) and cardiovascular and overall mortality after multivariate adjustments. Kaplan-Meier analysis depicted MACE-free events and survival during the follow-up time. Results: Of the 175 CHD patients, 38, 42, 45, and 50 exhibited small IVCD with eccentric and concentric LVH and large IVCD with eccentric and concentric LVH, respectively. Compared to small IVCD and eccentric LVH, large IVCD and eccentric LVH had the highest risk of MACEs, followed by large IVCD and concentric LVH (aHR: 4.40, 3.60; 95% CI: 1.58-12.23, 1.28-10.12, respectively). As for cardiovascular mortality, large IVCD and concentric LVH had the highest risk, followed by large IVCD and eccentric LVH, and small IVCD and concentric LVH. (aHR: 14.34, 10.23, 8.87; 95% CI: 1.99-103.35, 1.41-74.33; 1.01-77.87). The trend in overall mortality risk among the groups was similar to that of cardiovascular mortality. Conclusions: LVH geometry and IVCD co-modify the risk of MACEs and cardiovascular and overall mortality in CHD patients. The highest risk of MACEs is associated with large IVCD and eccentric LVH, while the highest risk of cardiovascular and overall mortality is linked with large IVCD and concentric LVH.

Keywords: concentric left ventricular hypertrophy; eccentric left ventricular hypertrophy; hemodialysis; inferior vena cava diameter; major cardiovascular event; mortality.

MeSH terms

Adult
Aged
Cardiovascular Diseases* / etiology
Cardiovascular Diseases* / mortality
Cohort Studies
Echocardiography / methods
Female
Heart Ventricles / diagnostic imaging
Heart Ventricles / physiopathology
Humans
Hypertrophy, Left Ventricular / complications
Hypertrophy, Left Ventricular / physiopathology
Kaplan-Meier Estimate
Male
Middle Aged
Proportional Hazards Models
Renal Dialysis* / adverse effects
Retrospective Studies
Risk Factors
Vena Cava, Inferior* / diagnostic imaging

Grants and funding

The study was supported by a grant from the Shin-Kong Wu Ho-Su Memorial Hospital and Taipei Medical University (Number SKH-TMU-111-01). The funding source played no role in this study.