Document Detail


Prognostic value of echocardiographic indicators of left ventricular systolic function in asymptomatic dialysis patients.
MedLine Citation:
PMID:  15034106     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Patients with end-stage renal disease (ESRD) are at high risk for heart failure, but the prevalence and the prognostic value of asymptomatic systolic dysfunction in these patients are unknown. In this prospective cohort study, the authors have therefore assessed by echocardiography the prevalence and the prognostic value of systolic function as estimated by ejection fraction (EF), fractional shortening at endocardial level (endoFS), and at midwall (mwFS), in a cohort of 254 asymptomatic dialysis patients. Systolic dysfunction had a prevalence rate of 26% by endoFS and of 48% by mwFS. During the follow-up period, 125 patients had one or more fatal and nonfatal CV events. On multivariate COX regression analysis, the three LV systolic function indicators were independently associated with incident fatal and nonfatal CV events, and there were no differences in the predictive power of these indicators (P > 0.30). The prediction power of LV function indicators was largely independent of traditional and novel risk factors in ESRD such as C-reactive protein and asymmetric dimethyl arginine (ADMA). ADMA was significantly related with LV function indicators as well as with mortality and incident CV events, but these links were much reduced (P = NS) in models including LV function indicators. Of note, the risk of CV events was minimal in patients with normal LV mass and function, intermediate in patients with either LVH or systolic dysfunction, and maximal in patients displaying both alterations. The study of myocardial contractility by echocardiography provides prognostic information independently of LV mass and other risk factors in ESRD. Risk stratification by simple systolic function parameters may prove useful in secondary prevention strategies in these patients.
Authors:
Carmine Zoccali; Francesco A Benedetto; Francesca Mallamaci; Giovanni Tripepi; Giuseppe Giacone; Alessandro Cataliotti; Giuseppe Seminara; Benedetta Stancanelli; Lorenzo S Malatino
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of the American Society of Nephrology : JASN     Volume:  15     ISSN:  1046-6673     ISO Abbreviation:  J. Am. Soc. Nephrol.     Publication Date:  2004 Apr 
Date Detail:
Created Date:  2004-03-22     Completed Date:  2004-10-26     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  9013836     Medline TA:  J Am Soc Nephrol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1029-37     Citation Subset:  IM    
Affiliation:
CNR-IBIM National Research Council, Institute of Biomedicine, Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Ospedali Riuniti via Vallone Petrara, 89124 Reggio Calabria, Italy. carmine.zoccali@tin.it
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MeSH Terms
Descriptor/Qualifier:
Aged
Cardiovascular Diseases / etiology,  physiopathology*,  ultrasonography*
Female
Humans
Kidney Failure, Chronic / complications,  physiopathology*,  therapy
Male
Middle Aged
Prevalence
Prognosis
Prospective Studies
Renal Dialysis*
Systole
Ventricular Function, Left*

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