Association between carotid sublayers thickness and cardiac alterations in dialysis patients.

Background: Left ventricular (LV) hypertrophy (LVH) and dysfunction are key contributors to the increased cardiovascular risk and are related to increased carotid intima-media thickness (cIMT) in hemodialysis (HD) patients. Although cIMT is considered a marker of atherosclerosis, examining its components - the intimal layer (cIT, associated with atherosclerosis) and the medial layer (cMT, linked to arteriosclerosis) - may provide deeper insights into the mechanisms of its association with LV remodeling. This study aimed to evaluate the relationship between carotid wall sublayers and LV alterations in HD patients.

Methods: This cross-sectional study evaluated 102 HD patients who underwent high-resolution ultrasound to evaluate cIMT, cIT, cMT, cIT/cMT ratio, and carotid plaques. LVH, LV geometric patterns, and LV diastolic dysfunction (E/e' > 14) and systolic dysfunction (global longitudinal strain [GLS] > -16% or LV ejection fraction [LVEF] < 50%) were evaluated using echocardiography.

Results: The studied sample had age = 57 ± 15 years, 59% males and median HD vintage = 17 [2, 36] months. Multivariable logistic regression analyses showed that LVH was associated with cIT (OR [95% CI] = 1.73 [1.13-2.67], p = .012), cIT/cMT ratio (OR [95% CI] = 1.24 [1.04-1.49], p = .015) and cIMT (OR [95% CI] = 1.41 [1.03-1.93], p = .031). Regarding LV geometric patterns, results of adjusted analyses showed that eccentric LVH was associated with cIT (OR [95% CI] = 1.64 [1.06-2.54], p = .027) and cIT/cMT ratio (OR [95% CI] = 1.25 [1.03-1.51]; p = .023). Conversely, E/e' > 14, GLS > -16% and LVEF < 50% showed no independent association with any carotid parameter.

Conclusions: cIT and cIT/cMT ratio were more closely associated with LVH and eccentric LVH than cIMT or cMT in HD patients, suggesting they may be potential novel markers of cardiovascular risk in this population.