title: A systolic parameter defined as the ratio of brachial pre-ejection period to brachial ejection time predicts cardiovascular events in patients with chronic kidney disease.
abstract: BACKGROUND
  Patients with chronic kidney disease (CKD) are associated with an increased risk of cardiovascular (CV) events. An increase in the ratio of the pre-ejection period (PEP) to ejection time (ET) is correlated with a decrease of left ventricular systolic function. Brachial PEP (bPEP) and brachial ET (bET) can be automatically determined from an ankle-brachial index (ABI)-form device. The aim of this study is to investigate whether bPEP/bET is a useful predictor for CV events in patients with CKD.
  
  
  RESULTS
  We consecutively enrolled 242 CKD patients from our outpatient department of internal medicine. The bPEP and bET were measured using an ABI-form device. CV events were defined as cardiac death, stroke, myocardial infarction, and hospitalization for congestive heart failure. The study subjects were followed until the first episode of CV events occurred. The relative CV event risk was analyzed by Cox-regression methods. In the multivariate analysis, the presence of diabetes (hazard ratio (HR), 3.531; P=0.014), increased bPEP/bET (HR, 1.054; P=0.026), and decreased serum albumin level (HR, 0.525; P=0.005) were independent predictors for CV events.
  
  
  CONCLUSIONS
  The study findings show that bPEP/bET is a useful predictor of CV events in CKD patients. Screening CKD patients by means of bPEP/bET might help to identify patients at high risk of increased CV events.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC.
authors.forename: Szu-Chia
authors.initials: SC
authors.lastname: Chen
authors.forename: Jer-Ming
authors.initials: JM
authors.lastname: Chang
authors.forename: Jer-Chia
authors.initials: JC
authors.lastname: Tsai
authors.forename: Tsung-Hsien
authors.initials: TH
authors.lastname: Lin
authors.forename: Po-Chao
authors.initials: PC
authors.lastname: Hsu
authors.forename: Ho-Ming
authors.initials: HM
authors.lastname: Su
authors.forename: Wen-Chol
authors.initials: WC
authors.lastname: Voon
authors.forename: Shang-Jyh
authors.initials: SJ
authors.lastname: Hwang
authors.forename: Hung-Chun
authors.initials: HC
authors.lastname: Chen
mesh_terms: D000368:Aged; D055109:Ankle Brachial Index / Q000379:methods*; D002318:Cardiovascular Diseases / Q000209:etiology*; D003643:Death; D005260:Female; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D011237:Predictive Value of Tests; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D020521:Stroke / Q000209:etiology; D013599:Systole; D018487:Ventricular Dysfunction, Left