Abstract: TH-OR009

Ratio of Early Mitral Inflow Velocity to Global Diastolic Strain Rate and Global Left Ventricular Longitudinal Systolic Strain Predicts Overall Mortality and Cardiovascular Events in Hemodialysis

Session Information

Category: Dialysis

  • 601 Standard Hemodialysis for ESRD

Authors

  • Huang, Jiun-Chi, Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
  • Chen, Szu-Chia, Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
  • Chang, Jer-Ming, Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
Background

The associations between the ratio of early mitral inflow velocity (E) to global diastolic strain rate (E’sr) and global left ventricular longitudinal systolic strain (GLS) obtained from two-dimensional speckle-tracking echocardiography with cardiovascular (CV) outcomes remain unclear in patients undergoing hemodialysis (HD). This study aimed to examine the ability of E/E’sr ratio and GLS to predict overall mortality and CV events in maintenance HD patients.

Methods

Echocardiography was performed in 190 HD patients. E’sr and GLS were measured from three standard apical views using the index beat method. CV events were defined as CV death, non-fatal stroke, coronary artery disease, peripheral artery disease and heart failure.

Results

During the mean follow-up period of 2.7 years, 28 patients died and 28 CV events were recorded. After multivariate adjustment, the E/E’sr ratio (hazard ratio [HR]: 1.561; 95% confidence interval [CI], 1.221–1.995) and GLS (HR: 1.229; 95% CI, 1.061–1.423) were associated with overall mortality. Furthermore, the E/E’sr ratio (HR: 1.233; 95% CI, 1.001–1.518) and GLS (HR: 1.299; 95% CI, 1.104–1.529) were both associated with CV events in multivariate analysis. The E/E’sr ratio and GLS had a better predictive ability of overall mortality and CV events than the ratio of E to early diastolic mitral annular velocity (E’) and left ventricular ejection fraction (LVEF). Moreover, adding the E/E’sr ratio and GLS to a clinical model with conventional echocardiographic parameters improved the prediction of both mortality (p = 0.002) and CV events (p < 0.001).

Conclusion

The E/E’sr ratio and GLS are stronger than the E/E’ ratio and LVEF in predicting unfavorable outcomes, and may provide additional prognostic value to conventional clinical and echocardiographic parameters in maintenance HD patients.

Predictive values of echocardiographic parameters in relation to overall and cardiovascular events
ParametersOverall mortalityCardiovascular events
difference in likelihood ratiopdifference in likelihood ratiop
Basic model + ABI < 0.9, baPWV, CTR, AoAC17.6670.00121.900<0.001
Basic model + ABI < 0.9, baPWV, CTR, AoAC + LAVI, LVMI, LVEF, E/E’16.2120.00331.541<0.001
Basic model + ABI < 0.9, baPWV, CTR, AoAC + LAVI, LVMI, LVEF, E/E’ + E/E’sr, GLS12.1950.00297.735<0.001

p value was based on the incremental value compared with the basic model which was adjusted for demographic, clinical, and biochemical risk factors