Diastolic dysfunction is an independent predictor of cardiovascular events in incident dialysis patients with preserved systolic function

Jae Hyun Han, Ji Suk Han, Eun Jin Kim, Fa Mee Doh, Hyang Mo Koo, Chan Ho Kim, Mi Jung Lee, Hyung Jung Oh, Jung Tak Park, Seung Hyeok Han, Dong Ryeol Ryu, Tae Hyun Yoo, Shin Wook Kang

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Abstract

Background: Diastolic 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. Methods: This 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. Results: During 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. Conclusion: An increase in E/E' or LAVI is a significant risk factor for CV events in incident dialysis patients with preserved LV systolic function.

Original languageEnglish
Article numbere0118694
JournalPloS one
Volume10
Issue number3
DOIs
Publication statusPublished - 2015 Mar 4

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All Science Journal Classification (ASJC) codes

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

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