Echocardiographic changes in patients with stage 3-5 chronic kidney disease and left ventricular diastolic dysfunction.
BACKGROUND
Left ventricular (LV) diastolic dysfunction in chronic kidney disease (CKD) patients frequently leads to the development of congestive heart failure. We evaluated changes in echocardiographic parameters among CKD patients with LV diastolic dysfunction.


METHODS
We examined 70 ambulatory patients with CKD at stages 3-5 and 26 patients without CKD as a control group. Standard echocardiography and tissue Doppler imaging were performed on all patients. Patients with CKD were divided into two groups according to the results of lateral mitral early diastolic velocity (EmLVlat): a group with diastolic dysfunction (DD group; EmLVlat <8 cm/s) and a group without diastolic dysfunction (WDD group; EmLVlat ≥8 cm/s).


RESULTS
Compared to the patients in the WDD group, those in the DD group were characterized by lower values of mitral annular plane systolic excursion [MAPSE; 13 (11-17) vs. 14 (11-16) mm, p < 0.0001] and lateral mitral annular systolic velocity [SmLVlat; 7 (5-14) vs. 8 (5-13) cm/s, p = 0.006]. The area under the receiver operating characteristic (ROC) curve of the MAPSE level for the detection of LV diastolic dysfunction was 0.801 [95% CI 0.684-0.890, p < 0.0001], whereas a ROC-derived MAPSE value of ≤13 mm was characterized by a sensitivity of 84.4% and a specificity of 75.8% for diagnosing LV diastolic dysfunction. The only independent variable predicting LV diastolic dysfunction was MAPSE [OR = 0.39; 95% CI 0.21-0.74, p = 0.003].


CONCLUSIONS
We showed that reduced MAPSE, but not SmLVlat, is an independent predictive factor for LV diastolic dysfunction in CKD patients.
Department of Internal Diseases, Gastroenterology and Hepatology, University Clinical Hospital in Olsztyn, Olsztyn, Poland ; Department of Internal Diseases, Gastroenterology, Cardiology and Infectiology, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland.
Leszek
L
Gromadziński
Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland.
Piotr
P
Pruszczyk
Chronic kidney disease; Diastolic dysfunction; Tissue Doppler echocardiography