Evaluation of echocardiographic indices for the prediction of major adverse events during long-term follow-up in chronic hemodialysis patients with normal left ventricular ejection fraction.

BACKGROUND Cardiovascular disease is the leading cause of mortality in endstage renal failure. Prognostic role of echocardiography has not been fully elucidated in chronic hemodialysis patients. AIM To assess the ability of Doppler echocardiographic parameters of left ventricular (LV) diastolic function along with conventional echocardiographic indices to predict long-term adverse major events in chronic hemodialysis patients with normal LV ejection fraction (EF). PATIENTS AND METHODS A total of 45 chronic hemodialysis patients (aged 49 +/- 15 years) were included to the study. All patients underwent complete standard and tissue Doppler imaging echocardiography before and immediately after hemodialysis session and were followed-up prospectively. Major outcome measure was the combination of all-cause death and hospitalization for any cardiovascular event. RESULTS During the follow up period (52 +/- 26 months) 23 major events occured (17 all-cause deaths and 6 cardiovascular events requring hospitalization). Post-dialytic values of mean left atrial diameter, mitral E (peak early mitral inflow velocity), E/Vp [ratio of mitral E to flow propagation velocity (Vp)] and E/Ea [ratio of mitral E to peak early diastolic mitral annular velocity (Ea)] (average of 4 segments of mitral annulus) were significantly higher in patients who had major events. In Cox proportional hazard analysis only E/Ea ratio predicted combined endpoint of all-cause mortality and nonfatal cardiovascular events (hazard ratio: 1.20; confidence interval: 1.03-1.39; p = 0.018). The optimum cut-off value for E/Ea determined by ROC curve analysis revealed that E/Ea ratio higher than 9.8 predicted future events with sensitivity of 74% and specificity of 86%. CONCLUSIONS E/Ea might be an accurate echocardiographic indice during long-term follow up for the prediction of major adverse events in chronic hemodialysis patients with normal LV EF.