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KMID : 0191120150300010044
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Journal of Korean Medical Science
2015 Volume.30 No. 1 p.44 ~ p.53
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Predictive Value of Echocardiographic Parameters for Clinical Events in Patients Starting Hemodialysis
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Han Seung-Seok
Cho Goo-Yeong
Park Youn-Su
Baek Seon-Ha
Ahn Shin-Young
Kim Se-Joong
Chin Ho-Jun
Chae Dong-Wan
Na Ki-Young
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Abstract
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Echocardiographic parameters can predict cardiovascular events in several clinical settings. However, which echocardiographic parameter is most predictive of each cardiovascular or non-cardiovascular event in patients starting hemodialysis remains unresolved. Echocardiography was used in 189 patients at the time of starting hemodialysis. We established primary outcomes as follows: cardiovascular events (ischemic heart disease, cerebrovascular disease, peripheral artery disease, and acute heart failure), fatal non-cardiovascular events, all-cause mortality, and all combined events. The most predictable echocardiographic parameter was determined in the Cox hazard ratio model with a backward selection after the adjustment of multiple covariates. Among several echocardiographic parameters, the E/e’ ratio and the left ventricular end-diastolic volume (LVEDV) were the strongest predictors of cardiovascular and non-cardiovascular events, respectively. After the adjustment of clinical and biochemical covariates, the predictability of E/e’ remained consistent, but LVEDV did not. When clinical events were further analyzed, the significant echocardiographic parameters were as follows: s’ for ischemic heart disease and peripheral artery disease, LVEDV and E/e’ for acute heart failure, and E/e’ for all-cause mortality and all combined events. However, no echocardiographic parameter independently predicted cerebrovascular disease or non-cardiovascular events. In conclusion, E/e’, s’, and LVEDV have independent predictive values for several cardiovascular and mortality events.
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KEYWORD
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Heart Failure, Diastolic, Echocardiography, Kidney Failure, Chronic, Renal Dialysis, Morbidity, Mortality
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