Left ventricular geometry and adverse cardiovascular events in chronic hemodialysis patients on prolonged therapy with ACE inhibitors.

Background: In addition to the absolute magnitude of left ventricular (LV) mass (LVM), the geometric pattern of the left ventricle might help explain the different tendency toward LV hypertrophy (LVH) regression seen under effective therapy in chronic hemodialysis patients.

Methods: Forty-five hemodialyzed uremic subjects, 17 patients with concentric LVH and 28 patients with eccentric LVH, were followed up with yearly echocardiography over 3 years while on monotherapy with angiotensin-converting enzyme (ACE) inhibitors. Predialysis blood pressure (BP) and percentage of interdialytic weight gain recorded during the month the echocardiographic study was performed were retrieved and averaged. Any adverse cardiovascular events occurring during the 3-year follow-up period also were recorded.

Results: Significant regression of LVH (P = 0.0028) was observed in the group as a whole during the 3 years on ACE-inhibitor therapy, mainly accounted for by a reduction in pulse pressure (PP; r = 0.45; P = 0.0017). After subgrouping patients according to LV geometry, an LVM reduction was observed only in the 17 patients with concentric LVH (P = 0.0003), whereas no difference was detected in subjects with eccentric LVH despite the same degree of BP reduction and hemoglobin level and Kt/V increases in both groups. Moreover, a greater incidence of cardiovascular events was observed in patients with eccentric LVH than in those with concentric LVH during the 3-year follow-up period.

Conclusion: The most important finding of this study is that eccentric LVH seems to be less responsive to ACE-inhibitor treatment and is associated with a greater incidence of adverse cardiovascular events compared with concentric LVH. Furthermore, the decrease in PP appears to be the main predictor of LVH regression in chronic hemodialysis patients on ACE-inhibitor therapy.