Key result
Severe diastolic dysfunction linked to ~233% higher 3-year CV mortality in CKD patients.
Why the study?
The clinical burden and prognostic role of diastolic dysfunction based on 2016 guidelines, as well as risk mapping of concomitant systolic and diastolic dysfunction for cardiovascular mortality, remained unclear in patients with CKD.
Do left ventricular systolic and diastolic dysfunction predict 3-year cardiovascular mortality in adult patients with chronic kidney disease?
Cohort (n=20,257)
No
Do left ventricular systolic and diastolic dysfunction predict 3-year cardiovascular mortality in adult patients with chronic kidney disease?
Severe diastolic dysfunction and reduced LVEF are independently and augmentatively associated with increased 3-year cardiovascular mortality in patients with chronic kidney disease.
Answers are grounded in this paper and cite their sources.
Severe diastolic dysfunction may aid CV risk stratification in CKD; leaves open whether it guides therapy or improves outcomes.
BACKGROUND: The clinical burden and prognostic role of diastolic dysfunction (DD), on the basis of the latest (2016) American Society of Echocardiography guidelines, remain unclear in patients with chronic kidney disease (CKD). Moreover, risk mapping of concomitant systolic dysfunction and DD to evaluate the hazard of cardiovascular (CV) mortality in patients with CKD remains unexplored. METHODS: This retrospective cohort study identified 20,257 adult patients who underwent comprehensive echocardiography between 2008 and 2016 at a tertiary medical center in central Taiwan. The patients were stratified by CKD stage, and 3-year CV mortality risk in each CKD stratum was estimated through multivariable Cox proportional-hazards modeling using left ventricular ejection fraction (LVEF) and DD grades on the basis of the 2016 American Society of Echocardiography guidelines as the main risk factors. RESULTS: Compared with patients with stages 1 and 2 CKD, those with stages 4 and 5 CKD had significantly lower left ventricular ejection fractions and more severe DD. Both left ventricular ejection fraction (<40% vs ≥60%; adjusted hazard ratio, 3.17; 95% CI, 2.54-3.97) and DD grade (severe DD vs normal diastolic function; adjusted hazard ratio, 3.33; 95% CI, 2.33-4.76) were independently associated with 3-year CV mortality in the entire study population and had comparable effect sizes. The corresponding adjusted hazard ratios further increased to 4.20 (95% CI, 2.45-7.21) and 4.54 (95% CI, 2.20-9.38) in patients with stages 4 and 5 CKD. Systolic dysfunction and DD demonstrated mutually augmentative effects on CV mortality. CONCLUSIONS: These findings suggest that the current practice of cardioprotection for patients with CKD should be prioritized at an early stage along with conventional nephroprotection.
No takes yet. Share an insight, caveat, or question.
Liang et al. (2021) conducted a cohort in Chronic Kidney Disease (n=20,257). Severe diastolic dysfunction vs. Normal diastolic function was evaluated on 3-year cardiovascular mortality (aHR 3.33, 95% CI 2.33-4.76). Severe diastolic dysfunction was independently associated with 3-year cardiovascular mortality in patients with chronic kidney disease (aHR 3.33; 95% CI 2.33-4.76 vs normal diastolic function).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: