Predictive Value of Echocardiographic Parameters for Clinical Events in Patients Starting Hemodialysis.
10.3346/jkms.2015.30.1.44
- Author:
Seung Seok HAN
1
;
Goo Yeong CHO
;
Youn Su PARK
;
Seon Ha BAEK
;
Shin Young AHN
;
Sejoong KIM
;
Ho Jun CHIN
;
Dong Wan CHAE
;
Ki Young NA
Author Information
1. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. kyna@snubh.org
- Publication Type:Original Article
- Keywords:
Heart Failure, Diastolic;
Echocardiography;
Kidney Failure, Chronic;
Renal Dialysis;
Morbidity;
Mortality
- MeSH:
*Echocardiography;
Female;
Heart Failure/*diagnosis/mortality;
Humans;
Kidney Failure, Chronic/mortality/*therapy;
Male;
Middle Aged;
Predictive Value of Tests;
Prognosis;
*Renal Dialysis;
Risk Factors;
Ventricular Function, Left/*physiology
- From:Journal of Korean Medical Science
2015;30(1):44-53
- CountryRepublic of Korea
- Language:English
-
Abstract:
Echocardiographic parameters can predict cardiovascular events in several clinical settings. However, which echocardiographic parameter is most predictive of each cardiovascular or non-cardiovascular event in patients starting hemodialysis remains unresolved. Echocardiography was used in 189 patients at the time of starting hemodialysis. We established primary outcomes as follows: cardiovascular events (ischemic heart disease, cerebrovascular disease, peripheral artery disease, and acute heart failure), fatal non-cardiovascular events, all-cause mortality, and all combined events. The most predictable echocardiographic parameter was determined in the Cox hazard ratio model with a backward selection after the adjustment of multiple covariates. Among several echocardiographic parameters, the E/e' ratio and the left ventricular end-diastolic volume (LVEDV) were the strongest predictors of cardiovascular and non-cardiovascular events, respectively. After the adjustment of clinical and biochemical covariates, the predictability of E/e' remained consistent, but LVEDV did not. When clinical events were further analyzed, the significant echocardiographic parameters were as follows: s' for ischemic heart disease and peripheral artery disease, LVEDV and E/e' for acute heart failure, and E/e' for all-cause mortality and all combined events. However, no echocardiographic parameter independently predicted cerebrovascular disease or non-cardiovascular events. In conclusion, E/e', s', and LVEDV have independent predictive values for several cardiovascular and mortality events.
