Key result
Higher E/E' ratio predicts ~15% greater CV mortality in dialysis patients with preserved systolic function.
Why the study?
The relationship between central BP and LV diastolic dysfunction, as well as its clinical implication for CV mortality, was not clear in ESKD patients with preserved systolic function.
Does LV diastolic dysfunction and elevated central systolic blood pressure predict cardiovascular mortality in ESKD patients with preserved LV systolic function?
Cohort (n=61)
No
Does LV diastolic dysfunction and elevated central systolic blood pressure predict cardiovascular mortality in ESKD patients with preserved LV systolic function?
Effect estimate: HR 1.150 (95% CI 1.010-1.309)
p-value: p=0.034
In ESKD patients with preserved LV systolic function, central systolic blood pressure is a significant risk factor for LV diastolic dysfunction, which independently predicts cardiovascular mortality.
Supports E/E' monitoring in preserved-EF dialysis patients; leaves open whether central SBP modification alters CV mortality.
BACKGROUND AND AIMS: Cardiovascular (CV) disease is the major cause of death in patients with end-stage kidney disease (ESKD). Left ventricular (LV) diastolic dysfunction reflects LV pressure overload and is common in patients with ESKD. Recently, there have been studies on the usefulness of central blood pressure (BP); however, the relationship between central BP and LV diastolic dysfunction is not clear in dialysis patients with preserved systolic function. The purpose of this study was to investigate the clinical implication of central BP on LV diastolic dysfunction and CV mortality in the ESKD patients with preserved LV systolic function. METHODS: This prospective observational cohort study investigated the effect of LV diastolic dysfunction on CV mortality in the ESKD patients with preserved systolic function using echocardiography. Vascular calcification was evaluated using the abdominal aortic calcification score, and aortic stiffness was determined by measuring pulse wave velocity (PWV). The predictors of CV mortality were analyzed using Cox proportional hazard analysis. RESULTS: The subjects were comprised of 61 patients, with an average age of 54 years, 20 males (32.8%), and 25 diabetics (41.0%). There were 39 patients on hemodialysis and 22 patients receiving peritoneal dialysis treatment. During the mean follow-up period of 79.3 months, 16 patients (26.2%) died, and 7 patients (11.4%) died of CV events. The central systolic BP and diabetes were independent risk factors for LV diastolic dysfunction. In addition, patients with LV diastolic dysfunction had an increased CV mortality. When left atrial volume index and PWV were adjusted, the E/E' ratio was found to be a predictor of CV mortality. CONCLUSIONS: Central systolic BP and diabetes were found to be significant risk factors for LV diastolic dysfunction. LV diastolic dysfunction can independently predict CV mortality in dialysis patients with preserved LV systolic function.
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Choi et al. (2021) conducted a cohort in End-stage kidney disease with preserved LV systolic function (n=61). E/E' ratio (Left ventricular diastolic dysfunction) vs. Normal E/E' ratio was evaluated on Cardiovascular mortality (HR 1.150, 95% CI 1.010-1.309, p=0.034). The E/E' ratio independently predicted cardiovascular mortality (HR 1.150) in dialysis patients with preserved systolic function, while central systolic blood pressure predicted diastolic dysfunction.
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