Clinical InvestigationImaging and Diagnostic TestingPrognostic role of subclinical left ventricular abnormalities and impact of transplantation in chronic kidney disease
Section snippets
Study design
From 1999 to 2001, baseline standard echocardiography and dobutamine stress echocardiography (DbE) were performed in 176 patients with stage 4 or 5 CKD, who were >18 years of age, without a pre-existing condition which was expected to limit their life expectancy to <6 months, and either on maintenance dialysis therapy (hemodialysis or peritoneal dialysis) or had a calculated glomerular filtration rate (GFR) of ≤30 mL/min using the Cockcroft-Gault equation.18 Of these, 129 patients with normal
Baseline characteristics (Table I)
Patients were dialysis-dependant (57% hemodialysis and 43% peritoneal dialysis) and predialysis (mean GFR 18.8 ± 7.0 mL/min); 55 were listed for transplantation at baseline. The low incidence of diabetes in this cohort is representative of the population of dialysis patients in Australia. The results of standard echocardiography are summarized in Table II, although the mean LVMI was increased, the left atrial size was normal. The baseline tissue characterization, including the difference in
Discussion
This study of patients with CKD confirms the prediction of adverse outcome based on resting subclinical LV dysfunction. Diastolic tissue velocity, as a marker of subclinical disease, added incremental value to clinical predictors of events. Renal transplantation improved overt LV abnormalities (volume and wall thickness) as well as markers of subclinical disease (tissue velocity and strain). Moreover, both overt LV parameters and subclinical abnormalities worsened in patients who remained on
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This study was supported in part by a grant-in-aid from the National Heart Foundation of Australia (G02B 0639).