A new systolic parameter defined as the ratio of brachial pre-ejection period to brachial ejection time predicts overall and cardiovascular mortality in hemodialysis patients

Abstract

Impaired left ventricular systolic function is an important cause of mortality in hemodialysis patients. An increase in the ratio of pre-ejection period (PEP) to ejection time (ET) is associated with a decrease in left ventricular systolic function. Brachial PEP (bPEP) and brachial ET (bET) can be automatically determined from an ankle-brachial index (ABI)-form device. The aim of this study was to investigate whether bPEP/bET was a useful predictor for overall and cardiovascular mortality in hemodialysis patients. We enrolled 212 hemodialysis patients in one regional hospital. The bPEP and bET were measured using an ABI-form device. The mean follow-up period was 28.3 ± 5.7 months. The relative mortality risk was analyzed by Cox-regression methods. Twenty-two deaths were recorded in 212 patients (10.4%). In a multivariate analysis, the bPEP/bET (hazard ratio [HR], 1.055; P¼0.047) and serum creatinine level (P¼0.029) were positively and negatively associated with overall mortality, respectively. In addition, increased bPEP/bET (HR, 1.080; P¼0.017), increased fasting glucose (P¼0.046) and decreased serum creatinine level (P¼0.004) were independent predictors for cardiovascular mortality. Our findings show that bPEP/bET, a surrogate of left ventricular systolic function, is a useful predictor for overall and cardiovascular mortality in hemodialysis patients. Screening hemodialysis patients by means of bPEP/bET may help to identify a high-risk group for increased mortality.

A Systolic Parameter Defined as the Ratio of Brachial Pre-Ejection Period to Brachial Ejection Time Predicts Cardiovascular Events in Patients With Chronic Kidney Disease

“…11 In addition, our recent study also showed the bPEP/bET, but neither bPEP nor bET, was an independent predictor for CV and overall mortality in hemodialysis patients. 12 In the present study, we found that the bPEP/bET, but neither bPEP nor bET, was an independently predictor of CV events in CKD patients, which was consistent with previous findings. It implies that patients with increased bPEP/bET, a marker of left ventricular systolic dysfunction, might be a high risk group for increased CV events in patients with CKD.…”

“…12 However, there was no study to evaluate the relationship between bPEP/bET and CV outcome in patients with CKD. The aim of this study was to investigate whether bPEP/bET is a useful predictor of CV events in patients with CKD.…”

Myocardial performance index derived from pre-ejection period as a novel and useful predictor of cardiovascular events in atrial fibrillation

“…Patients with reduced Ea and Sa values, in particular, have a poor prognosis [26]. Besides, left ventricular and left atrial size, left ventricular hypertrophy and left ventricular systolic function were reported to be able to predict CV outcomes [27][28][29][30]. In this study, although Ea, Sa, left ventricular dimensions, LAVI, LVMI, and LVEF were associated with increased CV events in the univariate analysis, the association became insignificant after the multivariate analysis.…”

Prognostic Cardiovascular Markers in Chronic Kidney Disease

“…The bPEP/bET ratio has been reported to be an independent predictor of adverse outcomes in patients with kidney disease, including CV events in patients with CKD stage 3-5 [59], and overall and CV mortality in patients receiving HD [60]. Therefore, screening patients with kidney disease using the bPEP/bET ratio may help to identify patients at high risk of CV events [59].…”