Treadmill exercise-induced E/e' elevation as a predictor of cardiovascular event in end-stage renal disease on peritoneal dialysis.
OBJECTIVE
Diastolic dysfunction is associated with cardiovascular (CV) events in end-stage renal disease (ESRD) on continuous ambulatory peritoneal dialysis (CAPD). However, conventional measurement of LA volume and E/e' using Doppler echocardiography has been limited to predict CV events in patients with ESRD on CAPD.


METHODS
From September 2007 to September 2008, 30 consecutive patients with exertional dyspnea in ESRD on CAPD and normal systolic function was prospectively enrolled and underwent laboratory testing, coronary angiography, and treadmill exercise stress echocardiography (TESE). We divided the patients according to the presence of exercise-induced change of E/e' tissue Doppler and investigated whether this factor predicted CV events in ESRD on CAPD.


RESULTS
Mean CAPD duration of all patients (70% male; mean age, 49 years) was 12 months. Patients with exercise-induced elevated E/e' (n = 12, 40%) and non-elevated E/e' (n = 18, 60%) demonstrated similar baseline characteristics. Exercise-induced elevated E/e' was predictable (cut-off value 14%, sensitivity 63%, and specificity 95%), with a hazard ratio of 1.13 (confidence interval, 1.03 to 1.24; p = 0.005), and significantly associated with CV events compared to the non-elevated E/e' group (log-rank, p = 0.007).


CONCLUSIONS
Exercise-induced elevated E/e' determined using TESE might be feasible to predict CV events in patients with ESRD on CAPD.
Division of Nephrology, Eulji University Hospital, Daejeon, Korea.
Jong Ho
JH
Shin
Division of Cardiology, Eulji University Hospital, Daejeon, Korea.
Ki-Woon
KW
Kang
Division of Nephrology, Eulji University Hospital, Daejeon, Korea.
Jung Ho
JH
Kim
Division of Cardiology, Eulji University Hospital, Daejeon, Korea.
Jung Yeon
JY
Chin
Department of Internal Medicine, Eulji University Hospital, Daejeon, Korea.
Nae Yu
NY
Kim
Division of Cardiology, Eulji University Hospital, Daejeon, Korea.
Sang Hyun
SH
Park
Division of Cardiology, Eulji University Hospital, Daejeon, Korea.
Won Ho
WH
Kim
Division of Cardiology, Eulji University Hospital, Daejeon, Korea.
Yu Jeong
YJ
Choi
Division of Cardiology, Eulji University Hospital, Daejeon, Korea.
Kyung Tae
KT
Jung
Diastolic dysfunction; Exercise treadmill test; Peritoneal dialysis, continuous ambulatory