title: Incremental Prognostic Value of Ventricular-Arterial Coupling over Ejection Fraction in Patients with Maintenance Hemodialysis.
abstract: BACKGROUND
  Left ventricular ejection fraction (LVEF) is a predictor of adverse outcomes in hemodialysis patients. LVEF is, however, an integral parameter determined by contractility, loading condition, and coupling. We sought to determine whether these components would better predict adverse outcomes and have incremental prognostic value over a validated clinical score and EF.
  
  
  METHODS
  Two hundred thirty-four hemodialysis patients were prospectively followed up for primary composite endpoint: all-cause death, nonfatal myocardial infarction, and hospitalization due to worsening heart failure (HF). Load-independent contractility (end-systolic elastance [Ees] and preload recruitable stroke work [PRSW]) and arterial afterload (arterial elastance [Ea]) were noninvasively estimated. Ventricular-arterial coupling was assessed using the Ea/Ees ratio. LV global longitudinal strain (GLS) and mitral E-wave over annular velocity E' ratio (E/E') were also measured.
  
  
  RESULTS
  During a median follow-up of 776 days, 30 patients developed the primary endpoint. Ees, PRSW, GLS, S', Ea/Ees, E/E', and EF were independently associated with the outcome after adjusting for the clinical score and prior HF hospitalization, whereas end-diastolic volume index or arterial afterload parameters were not. The nested Cox models indicated that Ea/Ees had independent and incremental predictive value over the model based on the score and either EF or E/E'. Furthermore, Ea/Ees continued to have predictive value after adjusting for GLS. The classification and regression analysis stratified event rates ranging from 4.2% to 68.8%.
  
  
  CONCLUSIONS
  LV contractility and Ea/Ees were independently associated with adverse outcome in hemodialysis patients. Ea/Ees had an incremental prognostic value over the clinical score and EF.
authors.affiliation: Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Gunma.
authors.forename: Masaru
authors.initials: M
authors.lastname: Obokata
authors.affiliation: Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Gunma.
authors.forename: Koji
authors.initials: K
authors.lastname: Kurosawa
authors.affiliation: Hidaka Hospital, Takasaki, Gunma.
authors.forename: Hideki
authors.initials: H
authors.lastname: Ishida
authors.affiliation: Hidaka Hospital, Takasaki, Gunma; Department of Nephrology, Heisei-Hidaka Clinic, Takasaki, Gunma.
authors.forename: Kyoko
authors.initials: K
authors.lastname: Ito
authors.affiliation: Hidaka Hospital, Takasaki, Gunma; Department of Medicine, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Ogawa
authors.affiliation: Hidaka Hospital, Takasaki, Gunma.
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Ando
authors.affiliation: Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Gunma.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Kurabayashi
authors.affiliation: Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Gunma; Menzies Research Institute Tasmania, Hobart, Australia. Electronic address: kazz.negishi@nifty.com.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Negishi
mesh_terms: D015984:Causality; D015897:Comorbidity; D004452:Echocardiography / Q000706:statistics & numerical data; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000000981:diagnostic imaging* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D006435:Renal Dialysis / Q000401:mortality*; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D015996:Survival Rate; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000401:mortality*
keywords: Contractility; Hemodialysis; Load-independent; Prognosis; Ventricular-arterial coupling