Predictive Value of Several Echo Parameters for Cardiovascular Events in Hemodialysis Patients with Mid-range and Preserved Ejection Fraction Heart Failure

摘要

Patients with end stage renal disease (ESRD) on hemodialysis (HD) are predisposed to higher rates of major cardiovascular events, through several well-known pathophysiological mechanisms. The rates of all-cause mortality are 6 to 10fold greater for these patients compared with general population. Furthermore, diabetes mellitus, history of cardiovascular disease, dialysis duration, and residual diuresis are factors related to cardiovascular events in hemodialysis. Whilst structural and functional echocardiographic abnormalities in dialyzed patients have been the surrogate for several survival studies, the predictive value of these echo parameters, are not clearly established in this field.In dialysis patients, it is still unclear which echo parameter is the best in determining cardiovascular outcome. The purpose of our study was to investigate the role of Doppler Echocardiography and Tissue Doppler Imaging (TDI) abnormalities, in providing predictive parameters for this particular population. The survival rates were analyzed by Kaplan-Meier curves and cardiac events predictors by Cox's proportional-hazards model. We found correlations between several echo measurements and cardiovascular events, especially diastolic dysfunction and impaired left ventricular parameters. We strongly recommend the use of these echocardiographic parameters in early detection of patients at high risk in order to reduce morbidity and mortality.