Diastolic dysfunction is an independent predictor of cardiovascular events in incident dialysis patients with preserved systolic function.
BACKGROUND
Diastolic heart failure (HF), the prevalence of which is gradually increasing, is associated with cardiovascular (CV) morbidity and mortality in the general population and, more specifically, in patients with end-stage renal disease (ESRD). However, the impact of diastolic dysfunction on CV outcomes has not been studied in incident dialysis patients with preserved systolic function.


METHODS
This prospective observational cohort study investigates the clinical consequence of diastolic dysfunction and the predictive power of diastolic echocardiographic parameters for CV events in 194 incident ESRD patients with normal or near normal systolic function, who started dialysis between July 2008 and August 2012.


RESULTS
During a mean follow-up duration of 27.2 months, 57 patients (29.4%) experienced CV events. Compared to the CV event-free group, patients with CV events had a significantly higher left ventricular (LV) mass index, ratio of early mitral flow velocity (E) to early mitral annulus velocity (E') (E/E'), LA volume index (LAVI), deceleration time, and right ventricular systolic pressure, and a significantly lower LV ejection fraction and E'. In multivariate Cox proportional hazard analysis, E/E'>15 and LAVI>32 mL/m2 significantly predicted CV events (E/E'>15: hazard ratio [HR] = 5.40, 95% confidence interval [CI] = 2.73-10.70, P< .001; LAVI>32 mL/m2: HR = 5.56, 95% CI = 2.28-13.59, P< .001]. Kaplan-Meier analysis revealed that patients with both E/E'>15 and LAVI>32 mL/m2 had the worst CV outcomes.


CONCLUSIONS
An increase in E/E' or LAVI is a significant risk factor for CV events in incident dialysis patients with preserved LV systolic function.
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Jae Hyun
JH
Han
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Ji Suk
JS
Han
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Eun Jin
EJ
Kim
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Fa Mee
FM
Doh
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Hyang Mo
HM
Koo
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Chan Ho
CH
Kim
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Mi Jung
MJ
Lee
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Hyung Jung
HJ
Oh
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Jung Tak
JT
Park
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Seung Hyeok
SH
Han
Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea.
Dong-Ryeol
DR
Ryu
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Tae-Hyun
TH
Yoo
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea; Severance Biomedical Science Institute, Brain Korea 21 PLUS project for Medical Science, Yonsei University College of Medicine, Seoul, Korea.
Shin-Wook
SW
Kang
D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology*; D003971:Diastole / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012307:Risk Factors; D013599:Systole / Q000502:physiology*; D014463:Ultrasonography