J Korean Med Sci.  2015 Jan;30(1):44-53. 10.3346/jkms.2015.30.1.44.

Predictive Value of Echocardiographic Parameters for Clinical Events in Patients Starting Hemodialysis

• Han SS
• Cho GY
• Park YS
• Baek SH
• Ahn SY
• Kim S
• Chin HJ
• Chae DW
• Na KY

• KMID: 2155446
• DOI: http://doi.org/10.3346/jkms.2015.30.1.44

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.

Keyword

Heart Failure, Diastolic; Echocardiography; Kidney Failure, Chronic; Renal Dialysis; Morbidity; Mortality

MeSH Terms

*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

Figure

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  Fig. 1 Fitted curves between the strongest predictive echocardiographic parameters and the hazard ratios of cardiovascular (A) and non-cardiovascular (B) events. HR, hazard ratio; E, early diastolic transmitral inflow velocity; e', early diastolic mitral annular velocity; LVEDV, left ventricular end-diastolic volume.

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  Fig. 2 Fitted curves between the mitral annular systolic velocity (s') and the hazard ratios of ischemic heart disease (A) and peripheral artery disease (B). HR, hazard ratio; s', mitral annular systolic velocity.

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  Fig. 3 Fitted curves of the hazard ratios for acute heart failure with left ventricular end-diastolic volume (A) or E/e' (B). HR, hazard ratio; LVEDV, left ventricular end-diastolic volume; E, early diastolic transmitral inflow velocity; e', early diastolic mitral annular velocity.

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