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Left Ventricular Systolic Function Monitoring in Asymptomatic Dialysis Patients: A Prospective Cohort Study

Carmine Zoccali^*, Francesco A. Benedetto, Giovanni Tripepi^*, Francesca Mallamaci^*, Francesco Rapisarda, Giuseppe Seminara, Graziella Bonanno and Lorenzo S. Malatino

^* National Research Council-Institute of Biomedicine, Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension of Reggio Calabria and Cardiology Unit, Morelli Hospital, Reggio Calabria, and Institute of Internal Medicine, Catania University, Catania, Italy

Address correspondence to: Prof. Carmine Zoccali, CNR-IBIM Consiglio Nazionale delle Ricerche, Istituto di Biomedicina, Epidemiologia Clinica e Fisiopatologia, delle Malattie Renali e dell’Ipertensione Arteriosa, c/o Divisione di Nefrologia e Dialisi, Ospedali Riuniti Via Vallone Petrara, 89124, Reggio Calabria, Italy. Phone: +39-0965-397010; Fax: +39-0965-397000; E-mail: carmine.zoccali{at}tin.it

Received for publication November 30, 2005. Accepted for publication March 2, 2006.

Although it is well established that compromised systolic function predicts cardiovascular (CV) complications in symptomatic and asymptomatic patients with ESRD, it still is unknown whether repeated echocardiographic measurements of systolic function in asymptomatic patients with ESRD is useful for monitoring the evolution of cardiomyopathy in these patients. The prognostic value for CV events of changes in systolic function, as measured by midwall fractional shortening (mwFS) in a cohort of 191 dialysis patients, was tested. Echocardiography was performed twice, 17 ± 2 mo apart. Changes in mwFS (ch-mwFS) that occurred between the second and the first echocardiographic studies then were used to predict CV events during the ensuing 27 ± 13 mo. After the second echocardiographic study, 85 patients had incident CV events. In a Kaplan-Meier analysis, there was a graded increase in the risk for fatal and nonfatal CV events across ch-mwFS quartiles (P = 0.005). On multivariate Cox regression analysis, ch-mwFS maintained an independent association with CV outcomes. In this analysis, the risk for CV events was 51% lower in patients who manifested an increase in mwFS (hazard ratio 0.49; 95% confidence interval 0.27 to 0.88; P = 0.02) than in those who had a decrease in mwFS. Changes in mwFS have an independent prognostic value for CV events, and periodic echocardiographic studies of systolic function are useful for monitoring asymptomatic dialysis patients.

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Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673