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Updated: Apr 16, 2026
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Diastolic dysfunction is an independent predictor of cardiovascular events in incident dialysis patients with
Jae Hyun Han1, Ji Suk Han1, Eun Jin Kim1
1Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Insights
Diastolic dysfunction, indicated by increased E/E' or LAVI, significantly predicts cardiovascular events in new dialysis patients with preserved systolic function, highlighting a key risk factor.
Area of Science:
- Cardiology
- Nephrology
- Echocardiography
Background:
- Diastolic heart failure (HF) prevalence is rising, contributing to cardiovascular (CV) morbidity and mortality.
- Diastolic dysfunction's impact on CV outcomes remains understudied in incident dialysis patients with preserved systolic function.
Purpose of the Study:
- To investigate the clinical consequences of diastolic dysfunction in incident end-stage renal disease (ESRD) patients.
- To assess the predictive power of diastolic echocardiographic parameters for CV events in this population.
Main Methods:
- Prospective observational cohort study of 194 incident ESRD patients starting dialysis between July 2008 and August 2012.
- Focused on patients with normal or near-normal systolic function.
- Evaluated diastolic echocardiographic parameters and their association with CV events over a mean follow-up of 27.2 months.
Main Results:
- 57 patients (29.4%) experienced CV events during follow-up.
- Patients with CV events showed higher left ventricular (LV) mass index, E/E', LA volume index (LAVI), deceleration time, and right ventricular systolic pressure.
- Elevated E/E' (>15) and LAVI (>32 mL/m2) were significant predictors of CV events (HR=5.40 and HR=5.56, respectively).
Conclusions:
- Increased E/E' and LAVI are significant risk factors for CV events in incident dialysis patients with preserved LV systolic function.
- Combined elevated E/E' and LAVI indicate the worst CV outcomes.
Background:
Diastolic heart failure (HF), the prevalence of which is gradually increasing, is associated with cardiovascular (CV) morbidity and mortality in the general population and, more specifically, in patients with end-stage renal disease (ESRD). However, the impact of diastolic dysfunction on CV outcomes has not been studied in incident dialysis patients with preserved systolic function.
Methods:
This prospective observational cohort study investigates the clinical consequence of diastolic dysfunction and the predictive power of diastolic echocardiographic parameters for CV events in 194 incident ESRD patients with normal or near normal systolic function, who started dialysis between July 2008 and August 2012.
Results:
During a mean follow-up duration of 27.2 months, 57 patients (29.4%) experienced CV events. Compared to the CV event-free group, patients with CV events had a significantly higher left ventricular (LV) mass index, ratio of early mitral flow velocity (E) to early mitral annulus velocity (E') (E/E'), LA volume index (LAVI), deceleration time, and right ventricular systolic pressure, and a significantly lower LV ejection fraction and E'. In multivariate Cox proportional hazard analysis, E/E'>15 and LAVI>32 mL/m2 significantly predicted CV events (E/E'>15: hazard ratio [HR] = 5.40, 95% confidence interval [CI] = 2.73-10.70, P< .001; LAVI>32 mL/m2: HR = 5.56, 95% CI = 2.28-13.59, P< .001]. Kaplan-Meier analysis revealed that patients with both E/E'>15 and LAVI>32 mL/m2 had the worst CV outcomes.
Conclusion:
An increase in E/E' or LAVI is a significant risk factor for CV events in incident dialysis patients with preserved LV systolic function.
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