Predictors of Increased Left Ventricular Filling Pressure in Dialysis Patients with Preserved Left Ventricular Ejection Fraction

Aim

To study the left and right ventricular function and to assess the predictors of increased left ventricular (LV) filling pressure in dialysis patients with preserved LV ejection fraction.

Methods

This study included 63 consecutive patients (age 57 ± 14 years, 57% women) with end-stage renal failure. Echocardiography, including tissue Doppler measurements, was performed in all patients. Based on the median value of the ratio of transmitral early diastolic velocity to early myocardial velocity (E/E’ ratio), patients were divided into 2 groups: the group with high filling pressure (E/E’>10.16) and the group with low filling pressure (E/E’≤10.16).

Results

Compared with patients with low filling pressure, the group of patients with high filling pressure included a higher proportion of diabetic patients (41% vs 13%, P = 0.022) and had greater LV mass index (211 ± 77 vs 172 ± 71 g/m³, P = 0.04), lower LV lateral long axis amplitude (1.4 ± 0.3 vs 1.6 ± 0.3 cm, P = 0.01), higher E wave (84 ± 19 vs 64 ± 18cm/s, P < 0.001), lower systolic myocardial velocity (S’:8.6 ± 1.5 vs 7.0 ± 1.3 cm/s, P < 0.001), and lower diastolic myocardial velocities (E’: 6.3 ± 1.9 vs 9.5 ± 2.9 cm/s, P < 0.001; A’: 8.4 ± 1.9 vs 9.7 ± 2.5 cm/s, P = 0.018). Multivariate analysis identified LV systolic myocardial velocity – S’ wave (adjusted odds ratio, 1.909; 95% confidence interval, 1.060-3.439; P = 0.031) and age (1.053; 1.001-1.108; P = 0.048) as the only independent predictors of high LV filling pressure in dialysis patients.

Conclusions

In dialysis patients with preserved left ventricular ejection fraction, reduced systolic myocardial velocity and elderly age are independent predictors of increased left ventricular filling pressure.Cardiovascular disorders are the main cause of mortality and morbidity in patients with end-stage renal failure who are in regular hemodialysis programs (1,2). The left ventricular (LV) hypertrophy is a common finding in these patients. It reflects a physiological response to pressure and volume overload (3) and positively correlates with cardiovascular mortality (4). LV hypertrophy is frequently associated with LV dilatation and reduced systolic function (5). An increased incidence of atherosclerotic cardiovascular events in these patients has also been reported (6). Systolic dysfunction and LV hypertrophy have been identified as the best predictors of outcome in dialysis patients (4,7,8). However, the conventional systolic dysfunction appears in the late stages of the chronic renal failure (9).In contrast to conventional echocardiography, tissue Doppler imaging of the myocardial velocities overcomes the load dependence of diastolic parameters (10). The ratio of transmitral early diastolic velocity (E) to early myocardial velocity (E’) (E/E’ ratio) has been shown to be an accurate method of the LV filling pressure estimation (8) and the best predictor of LV diastolic filling in various cardiac pathologies (11,12), thereby serving as one of the best predictors of outcome in heart failure patients (13-15) and patients with end-stage renal disease (16).The aims of this study were to investigate the left and right ventricular function in patients with end-stage renal disease and preserved LV ejection fraction and to assess the predictors of increased LV filling pressure in these patients.