MP578GLOBAL LONGITUDINAL STRAIN, RATIO OF EARLY DIASTOLIC PEAK MITRAL FLOW VELOCITY TO EARLY MITRAL ANNULUS VELOCITY, AND CARDIOVASCULAR OUTCOME IN INCIDENT DIALYSIS PATIENTS

Abstract

INTRODUCTION AND AIMS: Both systolic and diastolic dysfunction of left ventricle (LV) may be associated with cardiovascular (CV) outcome in patients with end-stage renal disease (ESRD). Recently, speckle tracking and tissue Doppler echocardiography have been introduced. They can provide two sensitive and reproducible parameters of LV systolic and diastolic function, global longitudinal strain (GLS) and the ratio of early diastolic peak mitral flow velocity to early mitral annulus velocity (E/e'). METHODS: All patients enrolled in the prospective ESRD registry (2009∼2012) in our hospital were screened. Patients who had echocardiographic examination were selected. GLS was acquired in apical 4-, 3-, and 2-chamber views using 2-dimensional speckle tracking system. E/e' was obtained by pulse and tissue Doppler echocardiography with a standard protocol. CV composite endpoint was comprised of hospitalization for pulmonary edema, coronary artery disease (CAD) requiring intervention, and CV death. Patients were followed up until December 31, 2016. RESULTS: A total of 136 patients were analyzed. Mean [±standard deviation (SD)] age was 53.2±12.8 years old, and 49.3% was female. Median follow-up duration was 37.5 months (interquartile range: 13.4-59.2). Forty six patients experienced at least one CV event during follow-up (24 hospitalization for pulmonary edema, 13 CAD, and 16 CV death) Mean (±SD) GLS and E/e' were -13.35±3.66 and 13.6±5.0, respectively. GLS did not show an association with CV composite endpoint [hazard ratio (HR): 0.96, 95% confidence interval (CI): 0.87-1.06] after adjusting age, sex, diabetes, history of CAD, dyslipidemia, smoking, medications (anti-platelet agents, angiotensin II blockers, beta-blockers, and statins), systolic blood pressure, hemoglobin, serum albumin, total cholesterol, and C-reactive protein. On the other hand, one unit increase in E/e' was associated with 10% increase in the risk of CV composite endpoint (HR: 1.10, 95% CI: 1.03-1.17). CONCLUSIONS: Diastolic function as well as systolic function of LV is important for CV outcome in patients with ESRD. Both GLS and E/e' may play a pivotal role in estimating LV function and risk stratification even in these population.