Clinical and Echocardiographic Factors Associated with Right Ventricular Systolic Dysfunction in Hemodialysis Patients.
BACKGROUND
Chronic kidney disease is a disorder of epidemic proportions that impairs cardiac function. Cardiovascular diseases are the leading cause of death in hemodialysis patients, and the understanding of new nontraditional predictors of mortality could improve their outcomes. Right ventricular systolic dysfunction (RVSD) has recently been recognized as a predictor of cardiovascular death in heart failure and hemodialysis patients. However, the factors contributing to RVSD in hemodialysis patients remain unknown. The aim of this study was to evaluate the clinical and echocardiographic factors associated with RVSD in hemodialysis patients.


METHODS
A cross-sectional study was conducted in which 100 outpatients with end-stage renal disease on chronic hemodialysis were evaluated. A transthoracic echocardiographic examination was performed at optimal dry weight. Right ventricular systolic function was evaluated using tricuspid annular plane systolic excursion (TAPSE). Clinical and echocardiographic data were recorded for each patient. A multivariate linear logistic regression was created using RVSD (TAPSE <14 mm) as the dependent variable.


RESULTS
Fifteen patients with RVSD and 85 patients without RVSD were analyzed. TAPSE had a positive correlation with left ventricular ejection fraction (LVEF) and myocardial relaxation velocity. Independent contributors to RVSD were LVEF (OR 1.14, 95% CI 1.05-1.26), left ventricular mass index (OR 1.02, 95% CI 1.00-1.04), and myocardial relaxation velocity (OR 1.81, 95% CI 1.18-3.19).


CONCLUSIONS
Echocardiographic factors were significant contributors to RVSD. These measurements could be included as part of the routine workup in all end-stage renal disease patients on hemodialysis.
Department of Cardiology, Hospital Central 'Dr. Ignacio Morones Prieto', San Luis Potosí, México; Faculty of Medicine, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México.
Juan Manuel
JM
López-Quijano
Faculty of Medicine, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México; Department of Clinical Epidemiology, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México.
Antonio
A
Gordillo-Moscoso
Faculty of Medicine, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México.
Jesús Antonio
JA
Viana-Rojas
Department of Cardiology, Hospital Central 'Dr. Ignacio Morones Prieto', San Luis Potosí, México; Faculty of Medicine, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México.
Jorge
J
Carrillo-Calvillo
Faculty of Medicine, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México; Department of Clinical Epidemiology, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México.
Peter B
PB
Mandeville
Department of Cardiology, Hospital Central 'Dr. Ignacio Morones Prieto', San Luis Potosí, México; Faculty of Medicine, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México.
Alejandro
A
Chevaile-Ramos
Chronic kidney disease; Hemodialysis; Right ventricular dysfunction; Tricuspid annular plane systolic excursion