Impact of Left Ventricular Geometry on All-Cause Mortality in Patients Undergoing Hemodialysis

Key Points We evaluated the association between the four categories of left ventricular geometry and all-cause mortality in patients undergoing hemodialysis. Concentric hypertrophy was the most prevalent, followed by concentric remodeling, and these were associated with a high risk of mortality. Echocardiography screening for evaluating the four categories of left ventricular geometry may be useful for risk prediction in patients undergoing hemodialysis. Background Left ventricular (LV) geometry, which is classified into four categories on the basis of left ventricular mass index and relative wall thickness, can predict mortality more accurately than the presence of LV hypertrophy alone in patients with hypertension. However, this association remains inconclusive in patients undergoing maintenance hemodialysis. Methods We conducted a retrospective multicenter cohort study involving patients undergoing maintenance hemodialysis in Japan who underwent echocardiography between October 2006 and December 2021. The exposure of interest was LV geometry abnormalities (concentric remodeling, eccentric hypertrophy, and concentric hypertrophy). The primary outcome of this study was all-cause death. Results Among the 2228 patients included in the analysis (mean age, 67 years; 67% male individuals; median dialysis vintage, 1.5 years), 476 (21%) had normal geometry, 592 (27%) had concentric remodeling, 493 (22%) had eccentric hypertrophy, and 667 (30%) had concentric hypertrophy. During a median follow-up period of 3.8 years, 825 patients (37%) died. Compared with patients with normal geometry, those with concentric hypertrophy (adjusted hazard ratio [aHR], 1.32; 95% confidence interval [CI], 1.06 to 1.63) and concentric remodeling (aHR, 1.27; 95% CI, 1.02 to 1.58) had a higher risk of mortality. Eccentric hypertrophy was associated with a similar risk of mortality (aHR, 1.03; 95% CI, 0.81 to 1.30) compared with normal geometry. Conclusions Approximately 80% of patients undergoing maintenance hemodialysis exhibited abnormal LV geometry, with concentric hypertrophy being the most common pattern, followed by concentric remodeling. These abnormalities were associated with a higher risk of all-cause mortality compared with normal geometry. Risk prediction on the basis of the presence or absence of LV hypertrophy cannot consider concentric remodeling; therefore, echocardiography screening for evaluating the four categories of LV geometry may be beneficial in patients undergoing hemodialysis.