Diastolic Dysfunction as a Determinant of Pulmonary Hypertension in Patients with End Stage Renal Disease and Preserved Left Ventricular Ejection Fraction

Abstract

Background: The prevalence of pulmonary hypertension (PH) in patients with end-stage renal disease (ESRD) varies among different studies. Objective: To determine the prevalence and echocardiographic determinants of PH in patients with ESRD and preserved left ventricular (LV) ejection fraction. Materials and Methods: Patients with ESRD who underwent comprehensive transthoracic echocardiography were enrolled. PH was defined as mean pulmonary artery pressures of 25 mmHg or greater or pulmonary artery systolic pressure of 50 mmHg or greater. The propensity score matching, and multivariable logistic regression analyses were performed. Results: Three hundred two patients with a mean age of 49.1±14.6 years were included, of which 47% were female. The prevalence of PH was 42.7%. Diabetes mellitus, right ventricular dimension at basal level, LV ejection fraction, LV dimension, LV mass index, left atrial volume (LAV) index, early (E) and late diastolic velocity of mitral inflow, deceleration time of E and ratio of E, and tissue Doppler early diastolic velocity of mitral annulus (e’) were univariately associated with PH. Multivariate factors associated with PH were LAV index (OR 1.09, 95% CI 1.05 to 1.12, p<0.001), and E/e’ ratio (OR 1.12, 95% CI 1.05 to 1.20, p<0.001). In the propensity matched analysis, LAV index (OR 1.10, 95% CI 1.05 to 1.14, p<0.001) and E/e’ ratio (OR 1.12, 95% CI 1.08 to 1.29, p<0.001) remained as independent determinants of PH. Conclusion: In patients with ESRD and preserved LV ejection fraction, PH is common and the link between diastolic dysfunction and PH hasbeen demonstrated. Keywords: Chronic kidney disease; Diastolic dysfunction; End-stage renal disease; Left atrial volume; Pulmonary hypertension