Correlates of subclinical left ventricular dysfunction in ESRD

Fathi, Robert, Isbel, Nicole, Haluska, Brian, Case, Colin, Johnson, David W. and Marwick, Thomas H. (2003) Correlates of subclinical left ventricular dysfunction in ESRD. American Journal of Kidney Diseases, 41 5: 1016-1025. doi:10.1016/S0272-6386(03)00199-9


Author Fathi, Robert
Isbel, Nicole
Haluska, Brian
Case, Colin
Johnson, David W.
Marwick, Thomas H.
Title Correlates of subclinical left ventricular dysfunction in ESRD
Journal name American Journal of Kidney Diseases   Check publisher's open access policy
ISSN 0272-6386
Publication date 2003-05-01
Year available 2003
Sub-type Article (original research)
DOI 10.1016/S0272-6386(03)00199-9
Open Access Status Not yet assessed
Volume 41
Issue 5
Start page 1016
End page 1025
Total pages 10
Editor D. Gunderson
B. Kasiske
Place of publication New York
Publisher W.B. Saunders Co
Language eng
Subject C1
730106 Cardiovascular system and diseases
110201 Cardiology (incl. Cardiovascular Diseases)
Abstract Background. Abnormalities of the left ventricle are common in patients with end-stage renal disease (ESRD) both before and after the start of renal replacement therapy. The purpose of this study is to identify possible causes of subclinical left ventricular (LV) dysfunction in patients with ESRD. In particular, we sought to determine whether the presence of ESRD was itself associated with dysfunction independent of LV hypertrophy and coronary artery disease. Methods: Assessment of cardiovascular risk factors and dialysis adequacy was completed in 145 unselected patients with ESRD who were recruited from the renal dialysis unit and compared with age- and sex-matched controls. Among the 68 patients with ESRD who had undergone a dobutamine stress echocardiogram with normal findings, regional cardiac function was quantified by myocardial Doppler velocity, LV volumes and mass were measured using three-dimensional echocardiography, and vascular function was assessed using brachial artery reactivity (BAR). Results: LV diastolic velocity was impaired in patients with ESRD, but there was no significant difference in systolic velocity compared with control patients of similar age. Age, diabetes mellitus, hypertension, and LV mass were independent predictors of diastolic velocity (model R-2 = 0.45; P < 0.001), whereas age and risk factor number were predictors of systolic velocity (model R-2 = 0.19; P = 0.002). Increasing risk factor number had no significant relationship with LV mass or volume. There was no detected association between BAR and incremental risk factors (P = 0.51). Conclusion Subclinical LV dysfunction occurs in patients with ESRD, but is evidenced as abnormal myocardial diastolic, rather than systolic, function. Correlates of abnormal function are age, diabetes mellitus, hypertension, and LV mass, rather than ESRD alone, dialysis adequacy, or abnormal endothelial function.
Formatted abstract
Background: Abnormalities of the left ventricle are common in patients with end-stage renal disease (ESRD) both before and after the start of renal replacement therapy. The purpose of this study is to identify possible causes of subclinical left ventricular (LV) dysfunction in patients with ESRD. In particular, we sought to determine whether the presence of ESRD was itself associated with dysfunction independent of LV hypertrophy and coronary artery disease.

Methods: Assessment of cardiovascular risk factors and dialysis adequacy was completed in 145 unselected patients with ESRD who were recruited from the renal dialysis unit and compared with age- and sex-matched controls. Among the 68 patients with ESRD who had undergone a dobutamine stress echocardiogram with normal findings, regional cardiac function was quantified by myocardial Doppler velocity, LV volumes and mass were measured using three-dimensional echocardiography, and vascular function was assessed using brachial artery reactivity (BAR).

Results: LV diastolic velocity was impaired in patients with ESRD, but there was no significant difference in systolic velocity compared with control patients of similar age. Age, diabetes mellitus, hypertension, and LV mass were independent predictors of diastolic velocity (model R2 = 0.45; P < 0.001), whereas age and risk factor number were predictors of systolic velocity (model R2 = 0.19; P = 0.002). Increasing risk factor number had no significant relationship with LV mass or volume. There was no detected association between BAR and incremental risk factors (P = 0.51).

Conclusion: Subclinical LV dysfunction occurs in patients with ESRD, but is evidenced as abnormal myocardial diastolic, rather than systolic, function. Correlates of abnormal function are age, diabetes mellitus, hypertension, and LV mass, rather than ESRD alone, dialysis adequacy, or abnormal endothelial function.

Keyword Urology & Nephrology
End-stage Renal Disease (esrd)
Left Ventricle
Myocardial Doppler
Ventricular Volumes
Left Ventricular (lv) Dysfunction
Myocardial Doppler Velocity (mdv)
Renal Failure
Dobutamine Stress Echocardiography
Coronary-artery Disease
Stage Renal-disease
Long-axis Function
Risk-factors
Dialysis Patients
Endothelial Function
Heart-disease
Failure
Hypertrophy
Q-Index Code C1
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
2004 Higher Education Research Data Collection
School of Medicine Publications
 
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Created: Wed, 15 Aug 2007, 11:24:02 EST