Predictive value of echocardiographic parameters for clinical events in patients starting hemodialysis

Abstract

Echocardiographic parameters can predict cardiovascular events in several clinical settings.However, which echocardiographic parameter is most predictive of each cardiovascular ornon-cardiovascular event in patients starting hemodialysis remains unresolved.Echocardiography was used in 189 patients at the time of starting hemodialysis. Weestablished primary outcomes as follows: cardiovascular events (ischemic heart disease,cerebrovascular disease, peripheral artery disease, and acute heart failure), fatal noncardiovascularevents, all-cause mortality, and all combined events. The most predictableechocardiographic parameter was determined in the Cox hazard ratio model with abackward selection after the adjustment of multiple covariates. Among severalechocardiographic parameters, the E/e' ratio and the left ventricular end-diastolic volume(LVEDV) were the strongest predictors of cardiovascular and non-cardiovascular events,respectively. After the adjustment of clinical and biochemical covariates, the predictabilityof E/e' remained consistent, but LVEDV did not. When clinical events were furtheranalyzed, the significant echocardiographic parameters were as follows: s' for ischemicheart disease and peripheral artery disease, LVEDV and E/e' for acute heart failure, and E/e'for all-cause mortality and all combined events. However, no echocardiographic parameterindependently predicted cerebrovascular disease or non-cardiovascular events. Inconclusion, E/e', s', and LVEDV have independent predictive values for severalcardiovascular and mortality events.