title: Novel Approach to Cardiovascular Outcome Prediction in Haemodialysis Patients.
abstract: Cardiovascular mortality is high in haemodialysis (HD) patients. Arterial stiffness and global longitudinal strain (GLS) are important non-atheromatous cardiovascular risk predictors. No study has encompassed both parameters in a combined model for prediction of outcomes in HD patients. This is important because left ventricular (LV) dysfunction can result from fibrotic remodelling secondary to increased arterial stiffness.
  
  
  
  Two hundred and nineteen HD patients had pulse wave velocity (PWV) and echocardiography (including GLS) assessments. Patients were followed-up until death, transplantation or November 16, 2015, whichever happened first. Pearson's correlation coefficient was used to determine factors associated with PWV and GLS. A multivariable Cox regression model investigated factors associated with all-cause, cardiac death and events.
  
  
  
  One hundred and ninety eight HD patients had full datasets (median age 64.2, 68.7% males) with a mean LV ejection fraction (LVEF) of 61.7 ± 10.1% and GLS -13.5 ± 3.3%; 51% had LV hypertrophy. Forty eight deaths (15 cardiac) and 44 major cardiac events occurred during a median follow-up of 27.6 (25th-75th percentile, 17.3-32.7) months. In separate survival models, PWV and GLS were independently associated with all-cause mortality; however, in a combined model, LV mass indexed to height2.7 (LVMI/HT2.7; adjusted hazard ratio (HR) 1.02, 95% CI 1.00-1.04) and PWV (adjusted HR 1.23, 95% CI 1.03-1.47) were significant. PWV was neither associated with cardiac death nor associated with related cardiac events. However, GLS was associated with cardiac death (adjusted HR 1.24, 95% CI 1.00-1.54) and cardiac events (adjusted HR 1.13, 95% CI 1.03-1.25).
  
  
  
  PWV and LVMI/HT2.7 were superior to GLS in prediction of all-cause mortality. However, GLS was associated with cardiac death and events even when accounting for LVEF and LVMI/HT2.7.
authors.affiliation: Vascular Research Group, Institute of Population Health, The University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK.
authors.forename: Diana
authors.initials: D
authors.lastname: Chiu
authors.forename: Nik
authors.initials: N
authors.lastname: Abidin
authors.forename: Laura
authors.initials: L
authors.lastname: Johnstone
authors.forename: Michelle
authors.initials: M
authors.lastname: Chong
authors.forename: Vaidehi
authors.initials: V
authors.lastname: Kataria
authors.forename: Janet
authors.initials: J
authors.lastname: Sewell
authors.forename: Smeeta
authors.initials: S
authors.lastname: Sinha
authors.forename: Philip A
authors.initials: PA
authors.lastname: Kalra
authors.forename: Darren
authors.initials: D
authors.lastname: Green
mesh_terms: D000368:Aged; D015331:Cohort Studies; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D063177:Pulse Wave Analysis; D006435:Renal Dialysis; D016019:Survival Analysis; D006113:United Kingdom / Q000453:epidemiology