Abstract
Background. Diastolic dysfunction is common among dialysis patients and is associated with increased morbidity and mortality. Novel echocardiographic speckle tracking strain analysis permits accurate assessment of left ventricular diastolic function, independent of loading conditions and taking all myocardial segments into account. The aim of the study was to evaluate the prevalence of diastolic dysfunction in chronic dialysis patients using this novel technique, and to identify its determinants among clinical and echocardiographic variables. Methods. Patients currently enrolled in the ICD2 study protocol were included for this analysis. Next to conventional echo measurements diastolic function was also assessed by global diastolic strain rate during isovolumic relaxation (SRIVR). Results. A total of 77 patients were included (age 67 ± 8 years, 74% male). When defined as E/SRIVR ≥236, the prevalence of diastolic dysfunction was higher compared to more conventional measurements (48% versus 39%). Left ventricular mass (OR 1.02, 95% CI 1.00–1.04, P = 0.014) and pulse wave velocity (OR 1.34, 95% CI 1.07–1.68, P = 0.01) were independent determinants of diastolic dysfunction. Conclusion. Diastolic dysfunction is highly prevalent among dialysis patients and might be underestimated using conventional measurements. Left ventricular mass and pulse wave velocity were the only determinants of diastolic dysfunction in these patients.
Highlights
In dialysis patients, both cardiovascular and noncardiovascular mortality are significantly increased as compared to the general population [1]
Patients meeting current implantable cardioverter defibrillator (ICD) implantation criteria [8] and patients with severe comorbidities resulting in a life expectancy of less than one year are not considered for inclusion in the ICD2 study
A total of 89 patients currently enrolled in the ICD2 trial were included in this analysis
Summary
Both cardiovascular and noncardiovascular mortality are significantly increased as compared to the general population [1]. Cardiovascular mortality contributes to ∼40% of all-cause mortality in these patients, mainly due to sudden cardiac death [2] Several parameters, such as left ventricular hypertrophy (LVH) and left ventricular (LV) systolic dysfunction, have been identified as independent predictors of (cardiovascular) outcome in dialysis patients. Novel echocardiographic speckle tracking strain analysis permits accurate assessment of left ventricular diastolic function, independent of loading conditions and taking all myocardial segments into account. The aim of the study was to evaluate the prevalence of diastolic dysfunction in chronic dialysis patients using this novel technique, and to identify its determinants among clinical and echocardiographic variables. Left ventricular mass (OR 1.02, 95% CI 1.00–1.04, P = 0.014) and pulse wave velocity (OR 1.34, 95% CI 1.07–1.68, P = 0.01) were independent determinants of diastolic dysfunction. Left ventricular mass and pulse wave velocity were the only determinants of diastolic dysfunction in these patients
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