Siqueira TMA, Ferreira PAM, Monteiro Júnior FDC, Salgado Filho N, Ferreira ADSP, Santos Neto ED, Souza FLD, Cardoso PDT. Echocardiographic parameters as cardiovascular event predictors in hemodialysis patients.
Arq Bras Cardiol 2012;
99:714-23. [PMID:
22766916 DOI:
10.1590/s0066-782x2012005000065]
[Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Accepted: 03/17/2012] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND
Patients with chronic kidney disease (CKD) on hemodialysis have high rates of cardiovascular morbidity and mortality. Although structural and functional echocardiographic alterations in patients undergoing hemodialysis have been the subject of several survival analysis studies, the prognostic value of these alterations is not well established in literature.
OBJECTIVE
To determine the prognostic value of echocardiographic parameters in patients with CKD on hemodialysis.
METHODS
Sixty consecutive patients with CKD on hemodialysis were clinically evaluated and underwent Doppler echocardiography, being followed for 19 ± 6 months. The outcome measures were fatal and nonfatal cardiovascular events and overall mortality. The predictive value of echocardiographic variables was evaluated by Cox regression model and survival curves were constructed using the Kaplan-Meier method and log rank test to compare them.
RESULTS
Rates of survival free of cardiovascular events, of cardiovascular and overall mortality in two years were 79.4%, 88.5% and 83% respectively. Diabetes, previous diagnosis of cardiovascular disease (CVD), ejection fraction, fractional shortening, left ventricular systolic diameter and E/e' ratio were predictors of cardiovascular outcome at univariate analysis. In the multivariate analysis, previous history of CVD (HR = 6.17, 95%CI: 1.7 - 22.2, p = 0.005) and moderate to severe diastolic dysfunction (HR = 3.76, 95%CI: 1.05 - 13.4, p = 0.042) were independent risk factors for cardiovascular events.
CONCLUSION
Moderate to severe diastolic dysfunction is an independent predictor of cardiovascular events in hemodialysis patients.
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