Serum cystatin C level is associated with left atrial enlargement, left ventricular hypertrophy and impaired left ventricular relaxation in patients with stage 2 or 3 chronic kidney disease

Satoru Sakuragi, Keishi Ichikawa, Keiji Yamada, Masafumi Tanimoto, Takashi Miki, Hiroaki Otsuka, Kazuhiko Yamamoto, Kenji Kawamoto, Yusuke Katayama, Machiko Tanakaya, Hiroshi Itoh

Research output: Contribution to journalArticle

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Abstract

Background: Cystatin C is an endogenous marker of kidney function that overcomes the limitations of serum creatinine. High serum cystatin C levels have been associated with increased cardiovascular mortality and morbidity. In this cross-sectional study, we aimed to determine the associations between serum cystatin C levels and structural and functional cardiac changes in patients with stage 2 or 3 chronic kidney disease (CKD). Methods and results: We enrolled 429 consecutive patients (aged 24-97 years) with CKD stage 2 or 3 and left ventricular (LV) ejection fraction (LVEF) N 40%. Echocardiographic parameters, including LV mass index (LVMI), early diastolic mitral annulus velocity (e′ velocity), left atrial volume index (LAVI), and N-terminal of the prohormone brain natriuretic peptide (NT-proBNP) were measured. Patients were categorized into quartiles according to serum cystatin C levels. Cystatin C was associated with LAVI (p= 0.0055), LVEF (p = 0.0432), LVMI (p = 0.0409), e′ (p = 0.0051), E/e′ (p = 0.0027), and log-transformed NT-proBNP (p b 0.0001) according to multivariate linear regression analysis, after adjustment for confounding factors including creatinine-based estimated glomerular filtration rate (eGFRcreat) and urinary albumin to creatinine ratio. Incidence of eccentric and concentric hypertrophy increased with increasing cystatin C (Q1, 38%; Q2 49%; Q3, 51%; Q4, 66%, p = 0.0008), mainly because of increasing concentric hypertrophy (Q1, 30%; Q2, 39%; Q3, 39%; Q4, 51%, p = 0.0187). Conclusion: A high serum cystatin C is strongly associated with structural cardiac abnormalities such as LVH and left atrial enlargement, impaired LV relaxation, and an increased NT-proBNP, independently of eGFRcreat in patients with stage 2 or 3 CKD.

Original languageEnglish
Pages (from-to)287-292
Number of pages6
JournalInternational Journal of Cardiology
Volume190
Issue number1
DOIs
Publication statusPublished - Jul 1 2015

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Cystatin C
Left Ventricular Hypertrophy
Chronic Renal Insufficiency
Serum
Brain Natriuretic Peptide
Creatinine
Hypertrophy
Glomerular Filtration Rate
Stroke Volume
Albumins
Linear Models
Cross-Sectional Studies
Regression Analysis
Morbidity
Kidney
Mortality
Incidence

Keywords

  • Cystatin C
  • Left atrial enlargement
  • Left ventricular hypertrophy
  • LV relaxation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Serum cystatin C level is associated with left atrial enlargement, left ventricular hypertrophy and impaired left ventricular relaxation in patients with stage 2 or 3 chronic kidney disease. / Sakuragi, Satoru; Ichikawa, Keishi; Yamada, Keiji; Tanimoto, Masafumi; Miki, Takashi; Otsuka, Hiroaki; Yamamoto, Kazuhiko; Kawamoto, Kenji; Katayama, Yusuke; Tanakaya, Machiko; Itoh, Hiroshi.

In: International Journal of Cardiology, Vol. 190, No. 1, 01.07.2015, p. 287-292.

Research output: Contribution to journalArticle

Sakuragi, Satoru ; Ichikawa, Keishi ; Yamada, Keiji ; Tanimoto, Masafumi ; Miki, Takashi ; Otsuka, Hiroaki ; Yamamoto, Kazuhiko ; Kawamoto, Kenji ; Katayama, Yusuke ; Tanakaya, Machiko ; Itoh, Hiroshi. / Serum cystatin C level is associated with left atrial enlargement, left ventricular hypertrophy and impaired left ventricular relaxation in patients with stage 2 or 3 chronic kidney disease. In: International Journal of Cardiology. 2015 ; Vol. 190, No. 1. pp. 287-292.
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abstract = "Background: Cystatin C is an endogenous marker of kidney function that overcomes the limitations of serum creatinine. High serum cystatin C levels have been associated with increased cardiovascular mortality and morbidity. In this cross-sectional study, we aimed to determine the associations between serum cystatin C levels and structural and functional cardiac changes in patients with stage 2 or 3 chronic kidney disease (CKD). Methods and results: We enrolled 429 consecutive patients (aged 24-97 years) with CKD stage 2 or 3 and left ventricular (LV) ejection fraction (LVEF) N 40{\%}. Echocardiographic parameters, including LV mass index (LVMI), early diastolic mitral annulus velocity (e′ velocity), left atrial volume index (LAVI), and N-terminal of the prohormone brain natriuretic peptide (NT-proBNP) were measured. Patients were categorized into quartiles according to serum cystatin C levels. Cystatin C was associated with LAVI (p= 0.0055), LVEF (p = 0.0432), LVMI (p = 0.0409), e′ (p = 0.0051), E/e′ (p = 0.0027), and log-transformed NT-proBNP (p b 0.0001) according to multivariate linear regression analysis, after adjustment for confounding factors including creatinine-based estimated glomerular filtration rate (eGFRcreat) and urinary albumin to creatinine ratio. Incidence of eccentric and concentric hypertrophy increased with increasing cystatin C (Q1, 38{\%}; Q2 49{\%}; Q3, 51{\%}; Q4, 66{\%}, p = 0.0008), mainly because of increasing concentric hypertrophy (Q1, 30{\%}; Q2, 39{\%}; Q3, 39{\%}; Q4, 51{\%}, p = 0.0187). Conclusion: A high serum cystatin C is strongly associated with structural cardiac abnormalities such as LVH and left atrial enlargement, impaired LV relaxation, and an increased NT-proBNP, independently of eGFRcreat in patients with stage 2 or 3 CKD.",
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T1 - Serum cystatin C level is associated with left atrial enlargement, left ventricular hypertrophy and impaired left ventricular relaxation in patients with stage 2 or 3 chronic kidney disease

AU - Sakuragi, Satoru

AU - Ichikawa, Keishi

AU - Yamada, Keiji

AU - Tanimoto, Masafumi

AU - Miki, Takashi

AU - Otsuka, Hiroaki

AU - Yamamoto, Kazuhiko

AU - Kawamoto, Kenji

AU - Katayama, Yusuke

AU - Tanakaya, Machiko

AU - Itoh, Hiroshi

PY - 2015/7/1

Y1 - 2015/7/1

N2 - Background: Cystatin C is an endogenous marker of kidney function that overcomes the limitations of serum creatinine. High serum cystatin C levels have been associated with increased cardiovascular mortality and morbidity. In this cross-sectional study, we aimed to determine the associations between serum cystatin C levels and structural and functional cardiac changes in patients with stage 2 or 3 chronic kidney disease (CKD). Methods and results: We enrolled 429 consecutive patients (aged 24-97 years) with CKD stage 2 or 3 and left ventricular (LV) ejection fraction (LVEF) N 40%. Echocardiographic parameters, including LV mass index (LVMI), early diastolic mitral annulus velocity (e′ velocity), left atrial volume index (LAVI), and N-terminal of the prohormone brain natriuretic peptide (NT-proBNP) were measured. Patients were categorized into quartiles according to serum cystatin C levels. Cystatin C was associated with LAVI (p= 0.0055), LVEF (p = 0.0432), LVMI (p = 0.0409), e′ (p = 0.0051), E/e′ (p = 0.0027), and log-transformed NT-proBNP (p b 0.0001) according to multivariate linear regression analysis, after adjustment for confounding factors including creatinine-based estimated glomerular filtration rate (eGFRcreat) and urinary albumin to creatinine ratio. Incidence of eccentric and concentric hypertrophy increased with increasing cystatin C (Q1, 38%; Q2 49%; Q3, 51%; Q4, 66%, p = 0.0008), mainly because of increasing concentric hypertrophy (Q1, 30%; Q2, 39%; Q3, 39%; Q4, 51%, p = 0.0187). Conclusion: A high serum cystatin C is strongly associated with structural cardiac abnormalities such as LVH and left atrial enlargement, impaired LV relaxation, and an increased NT-proBNP, independently of eGFRcreat in patients with stage 2 or 3 CKD.

AB - Background: Cystatin C is an endogenous marker of kidney function that overcomes the limitations of serum creatinine. High serum cystatin C levels have been associated with increased cardiovascular mortality and morbidity. In this cross-sectional study, we aimed to determine the associations between serum cystatin C levels and structural and functional cardiac changes in patients with stage 2 or 3 chronic kidney disease (CKD). Methods and results: We enrolled 429 consecutive patients (aged 24-97 years) with CKD stage 2 or 3 and left ventricular (LV) ejection fraction (LVEF) N 40%. Echocardiographic parameters, including LV mass index (LVMI), early diastolic mitral annulus velocity (e′ velocity), left atrial volume index (LAVI), and N-terminal of the prohormone brain natriuretic peptide (NT-proBNP) were measured. Patients were categorized into quartiles according to serum cystatin C levels. Cystatin C was associated with LAVI (p= 0.0055), LVEF (p = 0.0432), LVMI (p = 0.0409), e′ (p = 0.0051), E/e′ (p = 0.0027), and log-transformed NT-proBNP (p b 0.0001) according to multivariate linear regression analysis, after adjustment for confounding factors including creatinine-based estimated glomerular filtration rate (eGFRcreat) and urinary albumin to creatinine ratio. Incidence of eccentric and concentric hypertrophy increased with increasing cystatin C (Q1, 38%; Q2 49%; Q3, 51%; Q4, 66%, p = 0.0008), mainly because of increasing concentric hypertrophy (Q1, 30%; Q2, 39%; Q3, 39%; Q4, 51%, p = 0.0187). Conclusion: A high serum cystatin C is strongly associated with structural cardiac abnormalities such as LVH and left atrial enlargement, impaired LV relaxation, and an increased NT-proBNP, independently of eGFRcreat in patients with stage 2 or 3 CKD.

KW - Cystatin C

KW - Left atrial enlargement

KW - Left ventricular hypertrophy

KW - LV relaxation

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