Abstract
Acoustic cardiography can provide simultaneous electrocardiography and acoustic cardiac data to assess the electronic and mechanical heart functions. The aim of this study was to assess whether changes in acoustic cardiographic parameters (ACPs) before and after hemodialysis (HD) are associated with overall and cardiovascular (CV) mortality in HD patients. A total of 162 HD patients was enrolled and ACPs were measured before and after HD, including left ventricular systolic time (LVST), systolic dysfunction index (SDI), third (S3) and fourth (S4) heart sounds, and electromechanical activation time (EMAT). During a follow-up of 2.9 years, 25 deaths occurred with 16 from CV causes. Multivariate analysis showed that high △SDI (per 1; hazard ratio [HR], 2.178; 95% confidence interval [CI], 1.189–3.990), high △EMAT (per 1%; HR, 2.218; 95% CI 1.382–3.559), and low △LVST (per 1 ms; HR, 0.947; 95% CI 0.912–0.984) were independently associated with increased overall mortality. In addition, high △EMAT (per 1%; HR, 2.141; 95% CI 1.117–4.102), and low △LVST (per 1 ms; HR, 0.777; 95% CI 0.637–0.949) were associated with increased CV mortality. In conclusion, the changes in ACPs before and after HD may be a useful clinical marker and stronger prognostic marker of overall and CV mortality than ACPs before HD.
Highlights
Acoustic cardiography can provide simultaneous electrocardiography and acoustic cardiac data to assess the electronic and mechanical heart functions
In the multivariable analysis after adjusting for age, sex, diabetes mellitus, hypertension, coronary artery disease, arteriovenous access type, dialysis vintage, systolic and diastolic blood pressures, albumin, log triglyceride, total cholesterol, hemoglobin, total calcium, phosphorous, calcium × phosphorus (CaXP) product, potassium, uric acid, Kt/V, blood flow, and medications including angiotensin converting enzyme inhibitors (ACEIs) and/or angiotensin II receptor blockers (ARBs), β-blocker, statin and aspirin, diabetes, high triglyceride, high hemoglobin, and patients withoutβ-blocker use were significantly associated with high △heart rate
High diastolic blood pressure, high triglyceride, high total calcium, high phosphorous, low CaXP product were associated with high △electromechanical activation time (EMAT)%
Summary
Acoustic cardiography can provide simultaneous electrocardiography and acoustic cardiac data to assess the electronic and mechanical heart functions. The aim of this study was to assess whether changes in acoustic cardiographic parameters (ACPs) before and after hemodialysis (HD) are associated with overall and cardiovascular (CV) mortality in HD patients. Cardiovascular (CV) disease is common in patients with ESRD, including coronary artery disease, left ventricular (LV) hypertrophy, heart failure and a rrhythmias[1,2], and it is the major cause of morbidity and mortality in dialysis patients[1]. Our recent study investigated ACPs in hemodialysis (HD) patients before and after HD, and found that the fourth heart sound (S4) and LV systolic time (LVST) were decreased and electromechanical activation time (EMAT) was increased after HD11. The aim of this study was to assess whether △ACPs before and after HD are associated with overall and CV mortality in HD patients
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