Role of cardiac magnetic resonance imaging and echocardiography in assessing the left ventricle in hemodialysis patients

Abstract

Background End-stage renal disease (ESRD) patients on hemodialysis (HD) are at increased risk for developing left ventricular hypertrophy (LVH), which is a predisposing factor for premature cardiovascular mortality. Although echocardiography (ECHO) has been the most commonly used technique for assessing LVH, cardiac magnetic resonance imaging (CMR) is now considered the gold standard and the most accurate tool for volume-independent determination of left ventricular mass (LVM). Objectives This study aimed to evaluate the agreement in LVM measurement and LVH detection between CMR and ECHO. Patients and methods A single-center, cross-sectional study including 30 ESRD patients on HD (group I) and 15, matched, healthy controls (group II) was performed to compare LVM measurement and LVH detection by ECHO and CMR. Result In both groups, ECHO overestimated LVM and left ventricular mass index (LVMI) in comparison with CMR. The Bland–Altman analysis demonstrated wider agreement limits (38.6 to −275.9 g) in LVM measurements by ECHO and CMR in group I (mean difference, 118.63 g, P≤0.001) than in group II (mean difference, 79.29 g; limits, −23.7 to −134.8 g, P≤0.001). Agreement was poor and not statistically significant in group I. Regarding LVMI measurement, there were wider agreement limits (145.5 to −18.8 g/m2) by ECHO and CMR in group I (mean difference, 63.33 g/m2, P≤0.001) than in group II (mean difference, 44 g/m2; limits, 71.3–16.7 g/m2, P≤0.001). Agreement was fair and statistically significant in group I. LVH prevalence by ECHO and CMR was 66.6 and 36.7%, respectively, in group I and 26.6 and 0%, respectively, in group II, with moderate agreement between both techniques (P=0.004) in group I. Conclusion ECHO overestimates LVM and LVMI as well as LVH detection in comparison with CMR in ESRD patients on HD. Therefore, for accurate assessment of LVM, CMR may be a better option to detect LVH in this high cardiovascular risk group.