Korean J Intern Med.  2013 Jan;28(1):35-44. 10.3904/kjim.2013.28.1.35.

Tissue Doppler-derived E/e' ratio as a parameter for assessing diastolic heart failure and as a predictor of mortality in patients with chronic kidney disease

• Kim MK
• Kim B
• Lee JY
• Kim JS
• Han BG
• Choi SO
• Yang JW

• KMID: 1793217
• DOI: http://doi.org/10.3904/kjim.2013.28.1.35

Abstract

BACKGROUND/AIMS
Diastolic dysfunction occurs frequently in patients with chronic kidney disease (CKD) and is associated with heart failure (HF) or mortality. We investigated whether the ratio of early diastolic mitral inflow velocity to early diastolic mitral annulus velocity (E/e' ratio), estimated using tissue Doppler imaging, has prognostic value for cardiovascular morbidity and all-cause mortality in patients with CKD.
METHODS
For 186 patients with CKD of stages III to V, we obtained echocardiograms with tissue Doppler imaging. A 5-year follow-up of 136 patients was performed based on hospital records and telephone interviews. The enrolled patients (79 males and 57 females) were categorized into the following CKD subgroups: stage III (n = 25); stage IV (n = 22); and stage V (n = 89).
RESULTS
The average follow-up period was 30.45 months and the mean age of the patients was 61.13 years. The mortality rate after 5 years was 60.0%. The causes of death were: sepsis, 21.9%; HF, 16.2%; and sudden death, 15.2%. Age (p = 0.000), increased C-reactive protein level (p = 0.018), and increased E/e' ratio (p = 0.048) were found to correlate with mortality. Age (p = 0.000), decreased ejection fraction (p = 0.003), and increased E/e' ratio (p = 0.045) correlated with cardiovascular event.
CONCLUSIONS
The E/e' ratio can predict mortality and cardiovascular events in patients with CKD who have diastolic dysfunction.

Keyword

Diastolic heart failure; Mortality; Echocardiography, Doppler; Chronic kidney disease

MeSH Terms

Aged
Chi-Square Distribution
*Echocardiography, Doppler
Female
Glomerular Filtration Rate
Heart Failure, Diastolic/*mortality/physiopathology/*ultrasonography
Humans
Incidence
Kaplan-Meier Estimate
Kidney/physiopathology
Linear Models
Male
Middle Aged
Mitral Valve/physiopathology/ultrasonography
Predictive Value of Tests
Prognosis
Proportional Hazards Models
ROC Curve
Renal Insufficiency, Chronic/diagnosis/*mortality/physiopathology
Republic of Korea/epidemiology
Risk Assessment
Risk Factors
Stroke Volume
Time Factors
Ventricular Function, Left