Influence of Left Ventricular Diastolic Dysfunction on Ischemic Heart Disease in Patients with Chronic Kidney Disease

Choi, Bo Kyung; Lee, Kyung Nam; Hwang, In Hye; Kim, Il Young; Rhee, Harin; Seoung, Eun Young; Song, Sang Heon; Lee, Dong Won; Lee, Soo Bong; Kwak, Ihm Soo

Abstract

BACKGROUND/AIMS
Cardiovascular complications are commonly seen in patients with chronic kidney disease (CKD). Recently, the prevalence of left ventricular diastolic dysfunction (LVDD) has increased, and the importance of LVDD has emerged in patients with CKD. The objectives of this study were to identify diagnostic criteria for LVDD related to ischemic heart disease (IHD) and evaluate the prognostic impact of diastolic dysfunction in patients with CKD.
METHODS
A total of 71 patients with CKD who were evaluated between January 2005 and May 2010 were included in this study. These patients were evaluated by conventional echocardiography and tissue Doppler imaging (TDI) for diastolic dysfunction.
RESULTS
Diagnostic cutoff values for LVDD related to IHD were E/E' = 15.55 (sensitivity: 100%, specificity: 64.7%, p = 0.005) and E/A = 0.79 (sensitivity: 84.6%, specificity: 55.9%, p = 0.006). Group I consisted of 19 patients with an E/E' > 15.55 and E/A > 0.79. Group II consisted of the remaining patients. Factors contributing to LVDD were age, history of ischemic heart disease, anemia, and high low-density lipoprotein (LDL) level. Factors contributing to IHD were LVDD, smoking, high LDL level, and high parathyroid hormone (PTH) level. The disease-free survival for IHD was significantly lower in group I compared to group II (p = 0.001). However, there was no significant difference in overall survival between groups I and II (p = 0.177).
CONCLUSIONS
Our study showed that moderate LVDD (E/E' > 15.55 and E/A > 0.79) in patients with CKD is positively associated with IHD.