Association between angiopoietin‐2 and functional cardiac remodeling in hemodialysis patients with normal left ventricular ejection

Cardiac remodeling is the initial process in heart failure development. The aim of this study is to evaluate the association between endothelium‐related biomarkers and cardiac remodeling in hemodialysis (HD) patients and how the presence of high blood pressure and diabetes mellitus modulates these associations. This was a cross‐sectional study with adult HD and normal left ventricular (LV) ejection fraction—LVEF—patients. The authors correlated several endothelium‐related biomarkers with echocardiographic indices—LV mass index (LVMi), LVEF, global longitudinal strain, mitral E/e’, and aortic root diameter. Seventy‐one patients were included, with 37 women (52.1%) and mean age of 54.3 ± 16.8 years. Angiopoietin‐2 (AGPT2) was inversely correlated with global longitudinal strain (r = ‐.374, p = .001) and directly with E/e’ (r = .265, p = .025). After adjustment, only AGPT2 was significantly associated with global longitudinal strain. blood pressure and diabetes mellitus were independent moderators for the AGPT2 and global longitudinal strain association. The conditional association was significant only when the mean pre‐HD blood pressure was above 97.5 mmHg or in diabetes mellitus patients. Finally, there was an interaction between diabetes mellitus and blood pressure when moderating the conditional effect of AGPT2 on global longitudinal strain. While in non‐diabetic patients, the association between AGPT2 with global longitudinal strain was significant only with pre‐HD blood pressure levels as high as 110 mmHg, in diabetic patients, this association was significant with pre‐HD blood pressure as low as 90 mmHg. Higher levels of AGPT2 were associated with worse cardiac function as determined by lower global longitudinal strain values. This association was moderated by blood pressure and diabetes mellitus, suggesting that the effects of AGPT2 on cardiac remodeling is dependent of such circumstances.