title: Ratio of transmitral E-wave velocity to early diastole mitral annulus velocity with cardiovascular and renal outcomes in chronic kidney disease.
abstract: OBJECTIVE
  Impaired left ventricular diastolic function and increased left ventricular filling pressure are frequently noted in patients with chronic kidney disease (CKD), even in early stages. The association of increased left ventricular filling pressure with cardiovascular and renal outcomes remains uncertain in CKD. This study is designed to assess whether the ratio of transmitral E-wave velocity (E) to early diastole mitral velocity (Ea) is associated with cardiovascular events and progression to dialysis in patients with CKD stages 3-5.
  
  
  METHODS
  This longitudinal study enrolled 356 predialysis CKD patients. Cardiovascular events were defined as cardiovascular death, hospitalization for unstable angina, nonfatal myocardial infarction, ventricular tachycardia, hospitalization for congestive heart failure, transient ischemia attack, and stroke. The renal endpoint was defined as commencement of dialysis. The relative cardiovascular events and renal endpoints risks were analyzed by Cox regression methods.
  
  
  RESULTS
  The high E/Ea was independently associated with old age, cerebrovascular disease, congestive heart failure, high systolic blood pressure, hypertriglyceridemia, low hemoglobin, proteinuria, and worse echocardiographic profiles. Besides, the high E/Ea increased the risk of cardiovascular events (hazard ratio (HR) 1.067; 95% confidence interval (CI) 1.017-1.119; p = 0.008) and progression to dialysis (HR 1.042; 95% CI 1.000-1.085; p = 0.048).
  
  
  CONCLUSIONS
  Our study in patients of CKD stages 3-5 demonstrated the high E/Ea was associated with increased cardiovascular events and progression to dialysis. Assessment of the E/Ea by Doppler echocardiography is useful for predicting the risk of adverse cardiovascular and renal outcomes in CKD patients.
authors.affiliation: Division of Nephrology, 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: Yi-Chun
authors.initials: YC
authors.lastname: Tsai
authors.forename: Jiun-Chi
authors.initials: JC
authors.lastname: Huang
authors.forename: Ling-I
authors.initials: LI
authors.lastname: Chen
authors.forename: Ho-Ming
authors.initials: HM
authors.lastname: Su
authors.forename: Shang-Jyh
authors.initials: SJ
authors.lastname: Hwang
authors.forename: Hung-Chun
authors.initials: HC
authors.lastname: Chen
mesh_terms: D017677:Age Distribution; D015897:Comorbidity; D004452:Echocardiography / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging*; D015995:Prevalence; D006435:Renal Dialysis / Q000401:mortality*; D051436:Renal Insufficiency, Chronic / Q000401:mortality* / Q000534:rehabilitation*; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D017678:Sex Distribution; D015996:Survival Rate; D013624:Taiwan / Q000453:epidemiology; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000401:mortality*