Masaru Obokata1, Koji Kurosawa1, Hideki Ishida2, Kyoko Ito3, Tetsuya Ogawa4, Yoshitaka Ando2, Masahiko Kurabayashi1, Kazuaki Negishi5. 1. Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Gunma. 2. Hidaka Hospital, Takasaki, Gunma. 3. Hidaka Hospital, Takasaki, Gunma; Department of Nephrology, Heisei-Hidaka Clinic, Takasaki, Gunma. 4. Hidaka Hospital, Takasaki, Gunma; Department of Medicine, Tokyo Women's Medical University Medical Center East, Tokyo, Japan. 5. Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Gunma; Menzies Research Institute Tasmania, Hobart, Australia. Electronic address: kazz.negishi@nifty.com.
Abstract
BACKGROUND:Left ventricular ejection fraction (LVEF) is a predictor of adverse outcomes in hemodialysis patients. LVEF is, however, an integral parameter determined by contractility, loading condition, and coupling. We sought to determine whether these components would better predict adverse outcomes and have incremental prognostic value over a validated clinical score and EF. METHODS:Two hundred thirty-four hemodialysis patients were prospectively followed up for primary composite endpoint: all-cause death, nonfatal myocardial infarction, and hospitalization due to worsening heart failure (HF). Load-independent contractility (end-systolic elastance [Ees] and preload recruitable stroke work [PRSW]) and arterial afterload (arterial elastance [Ea]) were noninvasively estimated. Ventricular-arterial coupling was assessed using the Ea/Ees ratio. LV global longitudinal strain (GLS) and mitral E-wave over annular velocity E' ratio (E/E') were also measured. RESULTS: During a median follow-up of 776 days, 30 patients developed the primary endpoint. Ees, PRSW, GLS, S', Ea/Ees, E/E', and EF were independently associated with the outcome after adjusting for the clinical score and prior HF hospitalization, whereas end-diastolic volume index or arterial afterload parameters were not. The nested Cox models indicated that Ea/Ees had independent and incremental predictive value over the model based on the score and either EF or E/E'. Furthermore, Ea/Ees continued to have predictive value after adjusting for GLS. The classification and regression analysis stratified event rates ranging from 4.2% to 68.8%. CONCLUSIONS:LV contractility and Ea/Ees were independently associated with adverse outcome in hemodialysis patients. Ea/Ees had an incremental prognostic value over the clinical score and EF.
RCT Entities:
BACKGROUND: Left ventricular ejection fraction (LVEF) is a predictor of adverse outcomes in hemodialysis patients. LVEF is, however, an integral parameter determined by contractility, loading condition, and coupling. We sought to determine whether these components would better predict adverse outcomes and have incremental prognostic value over a validated clinical score and EF. METHODS: Two hundred thirty-four hemodialysis patients were prospectively followed up for primary composite endpoint: all-cause death, nonfatal myocardial infarction, and hospitalization due to worsening heart failure (HF). Load-independent contractility (end-systolic elastance [Ees] and preload recruitable stroke work [PRSW]) and arterial afterload (arterial elastance [Ea]) were noninvasively estimated. Ventricular-arterial coupling was assessed using the Ea/Ees ratio. LV global longitudinal strain (GLS) and mitral E-wave over annular velocity E' ratio (E/E') were also measured. RESULTS: During a median follow-up of 776 days, 30 patients developed the primary endpoint. Ees, PRSW, GLS, S', Ea/Ees, E/E', and EF were independently associated with the outcome after adjusting for the clinical score and prior HF hospitalization, whereas end-diastolic volume index or arterial afterload parameters were not. The nested Cox models indicated that Ea/Ees had independent and incremental predictive value over the model based on the score and either EF or E/E'. Furthermore, Ea/Ees continued to have predictive value after adjusting for GLS. The classification and regression analysis stratified event rates ranging from 4.2% to 68.8%. CONCLUSIONS: LV contractility and Ea/Ees were independently associated with adverse outcome in hemodialysis patients. Ea/Ees had an incremental prognostic value over the clinical score and EF.
Authors: Jason V Tso; Casey G Turner; Chang Liu; Syed Ahmad; Abbas Ali; Steve Selvaraj; Angelo Galante; Carla R Gilson; Craig Clark; B Robinson Williams; Arshed A Quyyumi; Aaron L Baggish; Jonathan H Kim Journal: J Am Heart Assoc Date: 2022-02-24 Impact factor: 6.106