BACKGROUND: Diastolic dysfunction (DD) is frequent in patients on hemodialysis (HD), but its impact on the clinical evolution is yet to be established. OBJECTIVE: To evaluate the prevalence and prognostic impact of left ventricular (LV) advanced diastolic dysfunction (ADD) in patients on hemodialysis. METHODS: The echocardiograms were performed during the first year of HD therapy, in patients with sinus rhythm, with no evidence of cardiovascular disease, excluding those with significant valvopathy or pericardial effusion. The combined assessment of the Doppler echocardiographic data classified the diastolic dysfunction as: 1) normal diastolic function; 2) mild DD (relaxation alteration) and 3) ADD (pseudonormalization and restrictive flow pattern). The assessed outcomes were general mortality and cardiovascular events. RESULTS: A total of 129 patients (78 males), aged 52 +/- 16 years, with a DD prevalence of 73% (50% with mild DD and 23% with ADD) were included in the study. The group with ADD was older (p < 0.01) and presented higher systolic (p < 0.01) and diastolic BP (p = 0.043), LV mass (p < 0.01), left atrial volume index (p < 0.01) and number of diabetic patients (p = 0.019), as well as lower ejection fraction (EF) (p < 0.01). After 17 +/- 7 months, the general mortality was significantly higher in individuals with ADD, when compared to those with normal function and mild DD (p = 0.012, log rank test). At Cox multivariate analysis, ADD was predictive of cardiovascular events (hazard ratio 2.2; confidence interval: 1.1-4.3; p = 0.021) after adjusted for age, gender, diabetes, LV mass and EF. CONCLUSION: The subclinical ADD was identified in approximately 25% of the patients undergoing hemodialysis and had a prognostic impact, regardless of other clinical and echocardiographic data.
BACKGROUND:Diastolic dysfunction (DD) is frequent in patients on hemodialysis (HD), but its impact on the clinical evolution is yet to be established. OBJECTIVE: To evaluate the prevalence and prognostic impact of left ventricular (LV) advanced diastolic dysfunction (ADD) in patients on hemodialysis. METHODS: The echocardiograms were performed during the first year of HD therapy, in patients with sinus rhythm, with no evidence of cardiovascular disease, excluding those with significant valvopathy or pericardial effusion. The combined assessment of the Doppler echocardiographic data classified the diastolic dysfunction as: 1) normal diastolic function; 2) mild DD (relaxation alteration) and 3) ADD (pseudonormalization and restrictive flow pattern). The assessed outcomes were general mortality and cardiovascular events. RESULTS: A total of 129 patients (78 males), aged 52 +/- 16 years, with a DD prevalence of 73% (50% with mild DD and 23% with ADD) were included in the study. The group with ADD was older (p < 0.01) and presented higher systolic (p < 0.01) and diastolic BP (p = 0.043), LV mass (p < 0.01), left atrial volume index (p < 0.01) and number of diabeticpatients (p = 0.019), as well as lower ejection fraction (EF) (p < 0.01). After 17 +/- 7 months, the general mortality was significantly higher in individuals with ADD, when compared to those with normal function and mild DD (p = 0.012, log rank test). At Cox multivariate analysis, ADD was predictive of cardiovascular events (hazard ratio 2.2; confidence interval: 1.1-4.3; p = 0.021) after adjusted for age, gender, diabetes, LV mass and EF. CONCLUSION: The subclinical ADD was identified in approximately 25% of the patients undergoing hemodialysis and had a prognostic impact, regardless of other clinical and echocardiographic data.
Authors: Jin Hee Jeong; Pei-Tzu Wu; Brandon Michael Kistler; Peter John Fitschen; Annabel Guzman Biruete; Shane Aaron Phillips; Mohamed M Ali; Bo Fernhall; Kenneth Robert Wilund Journal: J Nephrol Date: 2015-03-10 Impact factor: 3.902
Authors: Silvio Henrique Barberato; Minna Moreira Dias Romano; Adenalva Lima de Souza Beck; Ana Clara Tude Rodrigues; André Luiz Cerqueira de Almeida; Bruna Morhy Borges Leal Assunção; Eliza de Almeida Gripp; Fabio Villaça Guimarães Filho; Henry Abensur; José Maria Del Castillo; Marcelo Haertel Miglioranza; Marcelo Luiz Campos Vieira; Márcio Vinicius Lins de Barros; Maria do Carmo Pereira Nunes; Maria Estefania Bosco Otto; Renato de Aguiar Hortegal; Rodrigo Bellio de Mattos Barretto; Thais Harada Campos; Vicente Nicoliello de Siqueira; Samira Saady Morhy Journal: Arq Bras Cardiol Date: 2019-08-08 Impact factor: 2.000
Authors: LaTonya J Hickson; Sara M Negrotto; Macaulay Onuigbo; Christopher G Scott; Andrew D Rule; Suzanne M Norby; Robert C Albright; Edward T Casey; John J Dillon; Patricia A Pellikka; Sorin V Pislaru; Patricia J M Best; Hector R Villarraga; Grace Lin; Amy W Williams; Vuyisile T Nkomo Journal: J Am Coll Cardiol Date: 2016-03-15 Impact factor: 24.094