Associations between Myocardial Diastolic Dysfunction and Cardiovascular Mortality in Chronic Kidney Disease: A Large Single-Center Cohort Study

Liang, Hsin‐Yueh; Hsiao, Ya-Luan; Yeh, Hung‐Chieh; Ting, I-Wen; Lin, Chia-Hung; Chiang, Hsiu‐Yin; Kuo, Chin‐Chi

doi:10.1016/j.echo.2021.12.003

Cited by 21 publications

(18 citation statements)

References 46 publications

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“…In contrast to what was previously published 2,12 , in our cohort we did not find statistically significant association between typical CVRFs such as HT, DM, obesity, and dyslipidemia with mortality due to COVID-19. Interestingly, as reported by some authors 13,14 , we found that patients with lower GFR at admission estimated 16 . The present work coincides with these observations, thus reinforcing the theory of a potential anti-inflammatory action of these agents that would favor the clinical course of the disease.…”

Section: Discussionsupporting

confidence: 85%

“…Tennoe et al described that DD is associated with higher mortality among patients with systemic sclerosis and exceeds pulmonary hypertension with respect to predicting mortality 27 . Liang et al described the close link between chronic kidney disease progression and DD; together with systolic dysfunction it confers a higher mortality risk in patients with stages 3 to 5 14 . DD was shown as well to be associated with outcome in patients with decompensated cirrhosis; particularly an E/e′ ratio > 10 was independently associated with higher MELD score and mortality 28 .…”

Section: Discussionmentioning

confidence: 99%

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Impact of previous cardiac function status assessed by echocardiography on the outcome of COVID-19

Carrión

Olmos

Luaces

et al. 2022

Sci Rep

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More than 91,000 fatalities due to Coronavirus Disease 2019 (COVID-19) have occurred in Spain. Several factors are associated with increased mortality in this disease, including cardiovascular risk factors (CVRF). However, information on the cardiac function of patients prior to the onset of COVID-19 is scarce and the potential impact it may have is uncertain. The aim of the EchoVID study was to describe the potential association between CVRF and cardiac function status prior to SARS-CoV-2 infection and in-hospital mortality. We studied clinical characteristics and cardiac function of patients admitted during the first wave of COVID-19. All patients had a transthoracic echocardiogram performed in the previous 12 months prior to diagnosis; conventional systolic and diastolic function parameters were analyzed. Logistic regression analysis was performed to identify predictors of in-hospital mortality. We included 296 individuals. Median age was higher in the group of patients who died (81.0 vs 76.1 years; p = 0.007). No significant differences were found in CVRF. Survivors were more frequently receiving anticoagulation therapy (52.9% vs 70.8%; p = 0.003). LVEF, although preserved on average in both groups, was significantly lower in the group of deceased patients (56.9% vs 61.1%; p = 0.017). Average E/e′ ratio was higher in the deceased group (11.1 vs 10.1; p = 0.049). Five variables were found to be independently associated with in-hospital mortality due to COVID-19: Age, male gender, LVEF, E/e′ ratio and anticoagulation therapy. A model including these variables had an area under the ROC curve of 0.756 (CI 0.669–0.843). The echocardiographic variables included in the model significantly improved the discriminative power, compared to a model including only demographic data. Left ventricular ejection fraction and E/e′ ratio prior to SARS-CoV-2 infection are two easily-obtained echocardiographic parameters that provide additional prognostic information over clinical factors when assessing patients admitted for SARS-CoV-2 infection.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Impact of previous cardiac function status assessed by echocardiography on the outcome of COVID-19

Carrión

Olmos

Luaces

et al. 2022

Sci Rep

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“…In the sensitivity analysis of matching CTR values with available echocardiographic parameters such as ejection fraction, left ventricular mass index (LVMI), and left atrial volume index (LAVI), the increasing trends of LVMI, and LAVI were concordant with the increasing baseline CTR groups and CTR trajectory group (Supplementary Table 2 ). Detailed information about the CMUH echocardiographic cohort has been published previously 24 , 34 .…”

Section: Resultsmentioning

confidence: 99%

Cardiothoracic ratio values and trajectories are associated with risk of requiring dialysis and mortality in chronic kidney disease

et al. 2023

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Background The prognostic role of the cardiothoracic ratio (CTR) in chronic kidney disease (CKD) remains undetermined. Methods We conducted a retrospective cohort study of 3117 patients with CKD aged 18–89 years who participated in an Advanced CKD Care Program in Taiwan between 2003 and 2017 with a median follow up of 1.3(0.7–2.5) and 3.3(1.8–5.3) (IQR) years for outcome of end-stage renal disease (ESRD) and overall death, respectively. We developed a machine learning (ML)–based algorithm to calculate the baseline and serial CTRs, which were then used to classify patients into trajectory groups based on latent class mixed modelling. Association and discrimination were evaluated using multivariable Cox proportional hazards regression analyses and C-statistics, respectively. Results The median (interquartile range) age of 3117 patients is 69.5 (59.2–77.4) years. We create 3 CTR trajectory groups (low [30.1%], medium [48.1%], and high [21.8%]) for the 2474 patients with at least 2 CTR measurements. The adjusted hazard ratios for ESRD, cardiovascular mortality, and all-cause mortality in patients with baseline CTRs ≥0.57 (vs CTRs <0.47) are 1.35 (95% confidence interval, 1.06–1.72), 2.89 (1.78–4.71), and 1.50 (1.22–1.83), respectively. Similarly, greater effect sizes, particularly for cardiovascular mortality, are observed for high (vs low) CTR trajectories. Compared with a reference model, one with CTR as a continuous variable yields significantly higher C-statistics of 0.719 (vs 0.698, P = 0.04) for cardiovascular mortality and 0.697 (vs 0.693, P < 0.001) for all-cause mortality. Conclusions Our findings support the real-world prognostic value of the CTR, as calculated by a ML annotation tool, in CKD. Our research presents a methodological foundation for using machine learning to improve cardioprotection among patients with CKD.

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“…This study suggested that the current practice of cardioprotection for CKD patients should be prioritized at an early stage. 9 The different echocardiographic changes and their clinical significance in CKD patients warrant some discussion. The diastolic dysfunction in patients with CKD may be multifactorial.…”

Section: Discussionmentioning

confidence: 99%

Echocardiographic Findings in Hemodialysis Patients in a Tertiary Care Hospital

Balqees

Hussain²,

Yusuf³

et al. 2022

PAFMJ

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Objective: To find out the echo abnormalities in a south Asian cohort on maintenance hemodialysis in a tertiary care hospital. Study Design: Descriptive cross-sectional study. Place and Duration of Study: Combined Military Hospital Abbottabad, from Feb 2022 to Apr 2022. Methodology: 57 adult patients on maintenance hemodialysis had a non-contrast transthoracic echocardiographic study recording parameters of left and right ventricular systolic and diastolic function. Results: We had 57 patients. 71.9% (n=41) were male, and females 28.1% (n=16), diabetics 47.4 % (n=27), hypertensives 84.2%(n=48), smoking 28.1% (n=16); 15.8%(n=9) had some form of ischemic heart disease. Left ventricular hypertrophy was noted in 78.9% (n=45) of the entire patient population. 84% (n=48) of hypertensive patients had LVH. Overall, 82% (n=47) of hypertensive patients had some degree of diastolic dysfunction compared to non-hypertensive patients (p<0.0001). Diastolic dysfunction of Grades I, II, III was seen in 35.1%(n=20), 29.8%(n=17), 17.5% (n=10). Mean E/e' ratio was 24.9±15, with 40.3%(n=23) having a value ≥15. The LV systolic dysfunction noted was: Mild 26.3%(n=15), Moderate 19.3%(n=11), Severe 1.8%(n=1). For the medial mitral annular systolic velocity(s’) 19.3%(n=11) had normal s’, while 80.7%(n=46) had reduced s’.The mean Pulmonary artery acceleration time (PA-AT) was was <100 ms in 68.4%(n=39). The mean tricuspid plane systolic excursion (TAPSE) was < 17 mm in 19.3%(n=11) of patients indicating RV systolic dysfunction. The Minimum PASP was 16, max 64, mean 41.5±14mm Hg. Conclusion: In our study of CKD patients on regular hemodialysis, we found high rates of LVH, DD, LV systolic dysfunction,RV systolic function, and pulmonary hypertension. This creates a case for a larger scale study of these patients in a south Asian cohort as well as institution of a screening program in CKD patients on hemodialysis.

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Associations between Myocardial Diastolic Dysfunction and Cardiovascular Mortality in Chronic Kidney Disease: A Large Single-Center Cohort Study

Cited by 21 publications

References 46 publications

Impact of previous cardiac function status assessed by echocardiography on the outcome of COVID-19

Impact of previous cardiac function status assessed by echocardiography on the outcome of COVID-19

Cardiothoracic ratio values and trajectories are associated with risk of requiring dialysis and mortality in chronic kidney disease

Echocardiographic Findings in Hemodialysis Patients in a Tertiary Care Hospital

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