Diastolic Dysfunction Is an Independent Predictor of Cardiovascular Events in Incident Dialysis Patients with Preserved Systolic Function

Abstract

BackgroundDiastolic heart failure (HF), the prevalence of which is gradually increasing, is associated with cardiovascular (CV) morbidity and mortality in the general population and, more specifically, in patients with end-stage renal disease (ESRD). However, the impact of diastolic dysfunction on CV outcomes has not been studied in incident dialysis patients with preserved systolic function.MethodsThis prospective observational cohort study investigates the clinical consequence of diastolic dysfunction and the predictive power of diastolic echocardiographic parameters for CV events in 194 incident ESRD patients with normal or near normal systolic function, who started dialysis between July 2008 and August 2012.ResultsDuring a mean follow-up duration of 27.2 months, 57 patients (29.4%) experienced CV events. Compared to the CV event-free group, patients with CV events had a significantly higher left ventricular (LV) mass index, ratio of early mitral flow velocity (E) to early mitral annulus velocity (E’) (E/E’), LA volume index (LAVI), deceleration time, and right ventricular systolic pressure, and a significantly lower LV ejection fraction and E’. In multivariate Cox proportional hazard analysis, E/E’>15 and LAVI>32 mL/m2 significantly predicted CV events (E/E’>15: hazard ratio [HR] = 5.40, 95% confidence interval [CI] = 2.73–10.70, P< .001; LAVI>32 mL/m2: HR = 5.56, 95% CI = 2.28–13.59, P< .001]. Kaplan-Meier analysis revealed that patients with both E/E’>15 and LAVI>32mL/m2 had the worst CV outcomes.ConclusionAn increase in E/E’ or LAVI is a significant risk factor for CV events in incident dialysis patients with preserved LV systolic function.

Heart Failure with Preserved and Reduced Ejection Fraction in Hemodialysis Patients: Prevalence, Disease Prediction and Prognosis

“…It must therefore be suspected that HFpEF is highly prevalent in HD patients. Yet, although it has recently been shown that diastolic dysfunction is predictive of cardiovascular events in incident HD patients [17], its true prevalence, associated factors and clinical outcomes are still unknown. In the light of future therapeutic options it is essential that these patients are identified easily, categorized correctly and characterized thoroughly in order to enable optimal care.…”

Grading of Left Ventricular Diastolic Dysfunction with Preserved Systolic Function by the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging Recommendations Contributes to Predicting Cardiovascular Events in Hemodialysis Patients

“…In the assessment of diastolic function, several parameters and different criteria have been used for evaluations, and a relationship with patient prognosis and several parameters has been verified in a general population [20, 21] as well as in a dialysis population [8-10]. The prevalence and grades of DD have a prognostic impact [22], with a progressively increased risk of mortality being observed with the progression of DD [20], even in patients with a preserved LVEF [21].…”

“…LVDD and HFpEF are more prevalent than HFrEF in maintenance hemodialysis patients [7]. Previous studies identified diastolic dysfunction (DD), defined as an increased ratio of early mitral flow velocity (E) to early mitral annulus velocity (E’) (E/E’) and/or a high left atrium volume index, as an independent predictor of mortality in starting and chronic dialysis patients [8-10]. Therefore, echocardiography needs to be employed to confirm cardiovascular risks and guide treatments for ESRD patients on dialysis.…”

Ehokardiografija u ranoj detekciji poremećaja funkcije desne komore pri promjeni volumena krvi kod bolesnika na hemodijalizi

“…Program hronične HD vremenom poveća-va vrijednosti plućnog pritiska, a disfunkcija desne komore je glavni uzrok smrti pacijenata sa terminalnom bolesti bubrega [1][2][3][4][5].…”