title: Prognostic role of subclinical left ventricular abnormalities and impact of transplantation in chronic kidney disease.
abstract: OBJECTIVE
  The outcome of patients with chronic kidney disease (CKD) is influenced by overt left ventricular (LV) abnormalities. We sought the predictive value and treatment response of subclinical LV dysfunction in CKD.
  
  
  METHODS
  Resting and dobutamine stress echocardiography were used to identify LV enlargement, dysfunction, or ischemia in 176 patients with CKD. In 129 patients who had normal dobutamine stress echocardiography, myocardial tissue characterization was performed using tissue Doppler imaging and integrated backscatter. Clinical, biochemical, and echocardiographic parameters were recorded at baseline, and patients were followed up for cardiac events and all-cause mortality over 2.4 years. Follow-up echocardiographic and tissue characterization parameters were performed in 80 patients.
  
  
  RESULTS
  Previous cardiac history (HR 5.2, P = .002) and serum phosphate (HR 6.2, P = .001) were independent clinical predictors of events (model chi2 = 20.9). Diastolic tissue velocity (HR 0.8, P = .05) was an independent predictor of outcome, and its addition to clinical assessment added incremental prognostic information (model chi2 = 24.8, P < .001). Patients who underwent transplantation (n = 45) showed reduction of wall thickness (P < .001) and LV volumes (P < .001) and increases in diastolic tissue velocity (P = .007) and strain (P = .001), whereas these measurements worsened in those who remained on dialysis.
  
  
  CONCLUSIONS
  In patients with CKD, subclinical LV dysfunction is associated with adverse outcome. Subclinical disease can be improved by transplantation but progresses in patients who continue on dialysis.
authors: Department of Medicine, University of Queensland, Brisbane, Australia.
authors: Dhrubo J
authors: DJ
authors: Rakhit
authors: Xiaohong H
authors: XH
authors: Zhang
authors: Rodel
authors: R
authors: Leano
authors: Kirsten A
authors: KA
authors: Armstrong
authors: Nicole M
authors: NM
authors: Isbel
authors: Thomas H
authors: TH
authors: Marwick
mesh_terms: D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007674:Kidney Diseases / Q000150:complications* / Q000628:therapy*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D006435:Renal Dialysis; D018487:Ventricular Dysfunction, Left / Q000150:complications*