Abstract
Patients with end-stage renal disease are at an increased risk of cardiovascular diseases and associated mortality. Acoustic cardiography is a technique in which cardiac acoustic data is synchronized with electric information to detect and characterize heart sounds and detect heart failure early. The aim of this study was to investigate acoustic cardiographic parameters before and after hemodialysis (HD) and their correlations with ankle-brachial index (ABI), brachial-ankle pulse wave velocity (baPWV), and ratio of brachial preejection period to ejection time (bPEP/bET) obtained from an ABI-form device in HD patients. This study enrolled 162 HD patients between October 2016 and April 2018. Demographic, medical, and laboratory data were collected. Acoustic cardiography was performed before and after HD to assess parameters including third heart sound (S3), fourth heart sound (S4), systolic dysfunction index (SDI), electromechanical activation time (EMAT), and left ventricular systolic time (LVST). The mean age of the enrolled patients was 60.4 ± 10.9 years, and 86 (53.1%) patients were male. S4 (p < 0.001) and LVST (p < 0.001) significantly decreased after HD, but EMAT (p < 0.001) increased. Multivariate forward linear regression analysis showed that EMAT/LVST before HD was negatively associated with albumin (unstandardized coefficient β = ‐0.076; p = 0.004) and ABI (unstandardized coefficient β = ‐0.115; p = 0.011) and positively associated with bPEP/bET (unstandardized coefficient β = 0.278; p = 0.003). Screening HD patients with acoustic cardiography may help to identify patients at a high risk of malnutrition, peripheral artery disease, and left ventricular systolic dysfunction.
Highlights
End-stage renal disease (ESRD) is a serious health care issue, and patients with ESRD are at an increased risk of cardiovascular disease and mortality [1, 2]
Multivariate forward linear regression analysis showed that electromechanical activation time (EMAT)/left ventricular systolic time (LVST) before HD was negatively associated with albumin and ankle-brachial index (ABI) and positively associated with brachial preejection period (bPEP)/brachial ejection time (bET)
High EMAT/LVST was associated with low albumin, low ABI, and high bPEP/bET, which indicated malnutrition, peripheral artery disease (PAD), and Left ventricular (LV) dysfunction, respectively
Summary
End-stage renal disease (ESRD) is a serious health care issue, and patients with ESRD are at an increased risk of cardiovascular disease and mortality [1, 2]. Cardiac structural and functional abnormalities and traditional risk factors such as hypertension, age, diabetes, and dyslipidemia are known to increase the risk of cardiovascular disease [3, 4]. The early identification of these risk factors in these patients is crucial. Left ventricular (LV) dysfunction is highly prevalent in ESRD patients, and LV dysfunction is an important factor predisposing ESRD patients to sudden death [5,6,7]. Echocardiography is the most commonly used tool to assess cardiac function; its efficacy depends on the operator’s ability and it is timeconsuming [9]. Audicor acoustic cardiography is a simple technique in which cardiac acoustic data is synchronized
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