This Article Full Text Full Text (PDF) Data Supplement All Versions of this Article: 52/1/107    most recent HYPERTENSIONAHA.108.112334v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Wang, A. Y-M. Articles by Sanderson, J. E. Search for Related Content PubMed PubMed Citation Articles by Wang, A. Y-M. Articles by Sanderson, J. E. Related Collections Cardio-renal physiology/pathophysiology Hypertrophy Echocardiography Epidemiology

(Hypertension. 2008;52:107.)
© 2008 American Heart Association, Inc.

Original Articles

Left Ventricular Filling Pressure by Doppler Echocardiography in Patients With End-Stage Renal Disease

Angela Y-M. Wang; Mei Wang; Christopher W-K. Lam; Iris H-S. Chan; Yan Zhang; John E. Sanderson

From the Departments of Medicine and Therapeutics (A.Y-M.W., M.W., Y.Z., J.E.S.) and Chemical Pathology (C.W-K.L., I.H-S.C.), Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong. Current affiliations: Department of Medicine (A.Y-M.W., M.W.), Queen Mary Hospital, University of Hong Kong, Hong Kong; Department of Cardiovascular Medicine (J.E.S.), University of Birmingham, Edgbaston, Birmingham, United Kingdom.

Correspondence to Angela Yee-Moon Wang, University Department of Medicine, University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Rd, Pokfulam, Hong Kong. E-mail aymwang{at}hku.hk

Left ventricular hypertrophy and systolic dysfunction predict mortality in patients with end-stage renal disease. However, the prognostic value of left ventricular filling pressure has remained uncertain in this population. We evaluated whether the early mitral inflow velocity to peak mitral annulus velocity (E/Em) ratio, an estimate of left ventricular filling pressure by tissue Doppler imaging, has significant additional prognostic value to conventional echocardiographic parameters and other clinical and biochemical parameters in 220 patients with end-stage renal disease. The E/Em ratio was elevated (>15) in 62% of the patients. Multivariate analysis showed that an elevated E/Em ratio had the highest correlation with left ventricular volume index, followed by loss of residual glomerular filtration rate, increasing age, worsening ejection fraction, and diabetes. During the median follow-up of 48 months, the E/Em ratio emerged as an independent predictor of all-cause mortality (adjusted hazard ratio: 1.027; 95% CI: 1.003 to 1.051; P=0.026) and cardiovascular death (adjusted hazard ratio: 1.033; 95% CI: 1.002 to 1.065; P=0.035) in the multivariable Cox regression analysis. In addition, the E/Em ratio added significant incremental prognostic value for all-cause mortality (P=0.035) and cardiovascular death (P=0.035) beyond the standard clinical, biochemical, and dialysis parameters and echocardiographic measurements. In conclusion, the E/Em ratio displayed important additional long-term prognostic information above and beyond that of left ventricular mass and systolic function. Our data suggest that left ventricular filling pressure should be estimated during echocardiographic examination for additional prognostication in patients with end-stage renal disease.

Key Words: end-stage renal disease • mortality risk • tissue Doppler • left ventricular filling pressure

This article has been cited by other articles:

				A. Y.-M. Wang, C. W.-K. Lam, M. Wang, I. H.-S. Chan, S.-F. Lui, Y. Zhang, and J. E. Sanderson Diagnostic potential of serum biomarkers for left ventricular abnormalities in chronic peritoneal dialysis patients Nephrol. Dial. Transplant., June 1, 2009; 24(6): 1962 - 1969. [Abstract] [Full Text] [PDF]