AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Association of Renal Function Markers with Left Ventricular Geometry: The Impact of Phenotypic Discordance and Risk Factors in a Hispanic/Latino Cohort
By Farmani M, Fisher-hoch SP, McCormick JB et al.
Introduction/Background: Chronic kidney disease disproportionately impacts Hispanic/Latino adults, driven by diabetes and hypertension, with maladaptive left ventricular (LV) remodeling as its earliest cardiovascular consequence. Creatinine-based eGFR (eGFRcr) is limited by muscle mass and adiposity; cystatin C (eGFRcys) and eGFR discordance offer alternative risk stratification, yet their utility in predicting subclinical structural heart disease in this population remains underinvestigated. Using the Border Health Research Cohort (BHRC), we compared three eGFR markers and evaluated whether eGFR discordance is independently associated with pathologic LV remodeling. Methods/Approach: We analyzed 1,314 Hispanic/Latino adults from the BHRC (2012-2025). eGFR was estimated using 2021 CKD-EPI equations (eGFRcr, eGFRcys, eGFRcr-cys). Phenotypic discordance was defined as eGFRcys at least 30% lower than eGFRcr. Transthoracic echocardiography classified LV geometry using sex-specific thresholds. Multivariable regression models adjusted for age, sex, BMI, blood pressure, and HbA1c. Results/Data: Concentric remodeling predominated (46.5%); concentric hypertrophy rose from 4.4% (no diabetes) to 12.8% (diabetes) (Table 1). Among participants with diabetes and preserved filtration (eGFR 60 mL/min/1.73m2 or higher), eGFRcys (OR=3.65, 95%CI:1.37-9.77, p=0.010) and eGFRcr-cys (OR=2.52, 95%CI:1.02-6.23, p=0.044) uniquely unmasked high odds of concentric remodeling, whereas eGFRcr was insensitive (OR=1.37, p=0.152), showing cystatin C detects diabetes-driven cardiac remodeling invisible to creatinine (Table 2). HbA1c significantly modified the eGFR-LV mass association across all three markers (interaction p=0.011-0.032); the kidney-cardiac relationship was negligible at HbA1c 7% but became pronounced and significant at HbA1c 9%. Overall LV hypertrophy prediction was equivalent across formulas (AUC:0.814-0.816; all DeLong p greater than 0.29). Among 403 participants with dual eGFR, discordance was present in 24.6% and correlated with higher unadjusted LV mass (p=0.012); however, causal mediation revealed BMI accounted for 72.3% of this association (ACME=2.47 g/m2, p less than 0.001), rendering the direct kidney-mediated effect non-significant (p=0.701) (Figure 1). Conclusions: In Hispanic/Latino adults, cystatin C-based equations uniquely capture diabetes-driven concentric remodeling entirely missed by creatinine screening. eGFR discordance in this high-adiposity cohort primarily reflects metabolic burden rather than occult uremic cardiotoxicity, requiring population-specific recalibration of general risk frameworks. Poor glycemic control amplifies kidney-mediated cardiac remodeling, highlighting glycemic optimization and albuminuria screening as precision levers to interrupt early cardiorenal injury.