Volume Excess Causing Heart Failure With Normal Ejection Fraction Is a Strong Predictor of Mortality in Patients With End Stage Renal Disease

Aftab, Waqas; Varadarajan, Padmini; Rasool, Shuja; Gazallo, Juliana; Motabar, Ali; Ali, Hatem Abdel Rahman Helmy; Kore, Arputharaj; DeVera, Michel; Pai, Ramdas G.

doi:10.1016/s0735-1097(12)61893-2

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“…However, our observations have suggested that a number of these patients have elevated left atrial (LA) pressures by echocardiography despite achievement of euvolemic status clinically. 4 Echocardiography can assess both left and right atrial (RA) pressures in a reliable fashion. 5,6 The echocardiographic E/e' ratio as a measure of LA pressure has been shown to be predictive of mortality in patients with ESRD.…”

Section: Introductionmentioning

confidence: 99%

Prognostic implications of echocardiographic measures of left and right atrial pressures on survival in patients with end stage renal disease

et al. 2021

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Background: Volume excess is common in patients with end stage renal disease (ESRD).We examined the prognostic value of clinical and echocardiographic measures of left (LA) and right atrial (RA) hypertension in this population. Method:We prospectively collected demographic, clinical, pharmacological, echocardiographic data on 575 consecutive ESRD patients on hemodialysis undergoing cardiac evaluation before renal transplantation in a dedicated cardiac clinic. Survival was analyzed as a function of clinical and echocardiographic measures of LA and (RA) hypertension.Result: Elevated LA pressure was seen in 48% of the patients based on E/e' velocity ratio of ≥ 15, and 28% had elevated RA pressure based on inferior vena caval size.Physical examination grossly underestimated the prevalence of both LA and RA hypertension. Atrial pressures were normal in 46% and both atrial pressures were elevated in 20% of the patients. Elevated LA pressure in the presence of normal RA pressure was found in 30%. Over a period of 20 ± 8 months, there were 43 deaths. There was a graded increase in mortality with increases in LA and bi-atrial hypertension (p = .009).The 2-year mortality rate was 6% in those with normal atrial pressures, 13% in those with isolated LA hypertension and 28% in those with bi-atrial hypertension. Conclusion:Mitral E/e' ratio and inferior vena caval size are vastly more sensitive than physical examination for recognition of elevated atrial pressures and are strong predictors of survival in ESRD patients. Limited echocardiographic examination may have a role in ESRD patients undergoing dialysis to help achieve euvolemic status.

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Section: Introductionmentioning

confidence: 99%