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Published on: May 31, 2022
Temporal Changes in Left Ventricular Ejection Fraction After Initiating Hemodialysis
Asahi Oshima1,2, Yu Horiuchi1, Takuya Matsumoto1,3
1Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan.
Introduction:
Longitudinal changes in left ventricular ejection fraction (LVEF) after commencing hemodialysis and their prognostic implications remain poorly characterized.
Methods:
We studied 278 patients who started hemodialysis between 2010 and 2022, underwent echocardiography within 90 days, and had at least one follow-up study. LVEF trajectories were analyzed using linear mixed-effects models and locally weighted scatterplot smoothing. Mortality was assessed using baseline, 1-year landmark, and time-updated LVEF categories.
Results:
LVEF initially improved but then declined in the 32 patients with a baseline LVEF ≤ 40%, whereas it remained stable in those with a baseline LVEF > 40%. Baseline LVEF ≤ 40% was associated with higher mortality (adjusted HR: 2.97, 95% CI: 1.38-6.37), with mortality risk increasing if LVEF remained ≤ 40% at 1 year. Time-updated LVEF ≤ 40% was independently associated with mortality (adjusted HR: 4.41, 95% CI: 2.37-8.22).
Conclusions:
LVEF changes dynamically after initiation of hemodialysis, and serial assessments identify patients at higher risk of mortality.
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