Serial change in echocardiographic parameters and cardiac failure in end-stage renal disease.
Echocardiographic abnormalities are the rule in patients starting dialysis therapy and are associated with the development of cardiac failure and death. It is unknown, however, whether regression of these abnormalities is associated with an improvement in prognosis. As part of a prospective cohort study with mean follow-up of 41 mo, 227 patients had echocardiography at inception and after 1 yr of dialysis therapy. Improvements in left ventricular (LV) mass index, volume index, and fractional shortening were seen in 48, 48, and 46%, respectively. Ninety patients had developed cardiac failure by 1 yr of dialysis therapy. Twenty-six percent of the remaining 137 patients subsequently developed new-onset cardiac failure. The mean changes in LV mass index were 17 g/m(2) in those who subsequently developed cardiac failure compared with 0 g/m(2) among those who did not (P = 0.05). The corresponding values were -8 versus 0% for fractional shortening (P < 0.0001). The associations between serial change in both LV mass index and fractional shortening and subsequent cardiac failure persisted after adjusting for baseline age, diabetes, ischemic heart disease, and the corresponding baseline echocardiographic parameter. Regression of LV abnormalities is associated with an improved cardiac outcome in dialysis patients. Serial echocardiography adds prognostic information to one performed at baseline.
Foley
Robert N
RN
Divisions of Nephrology and Clinical Epidemiology, Memorial University, St. John's, Newfoundland, Canada.
Parfrey
Patrick S
PS
Divisions of Nephrology and Clinical Epidemiology, Memorial University, St. John's, Newfoundland, Canada.
Kent
Gloria M
GM
Divisions of Nephrology and Clinical Epidemiology, Memorial University, St. John's, Newfoundland, Canada.
Harnett
John D
JD
Divisions of Nephrology and Clinical Epidemiology, Memorial University, St. John's, Newfoundland, Canada.
Murray
David C
DC
Divisions of Nephrology Salvation Army Grace General Hospital, St. John's, Newfoundland, Canada (DCM).
Barre
Paul E
PE
Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada.
D000704:Analysis of Variance; D016009:Chi-Square Distribution; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000473:pathology; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology