Prognostic Value of Echocardiographic Indicators of Left Ventricular Systolic Function in Asymptomatic Dialysis Patients

Carmine Zoccali, Francesco A. Benedetto, Francesca Mallamaci, Giovanni Tripepi, Giuseppe Giacone, Alessandro Cataliotti, Giuseppe Seminara, Benedetta Stancanelli, Lorenzo S. Malatino

Research output: Contribution to journalArticle

131 Citations (Scopus)

Abstract

Patients with end-stage renal disease (ESRD) are at high risk for heart failure, but the prevalence and the prognostic value of asymptomatic systolic dysfunction in these patients are unknown. In this prospective cohort study, the authors have therefore assessed by echocardiography the prevalence and the prognostic value of systolic function as estimated by ejection fraction (EF), fractional shortening at endocardial level (endoFS), and at midwall (mwFS), in a cohort of 254 asymptomatic dialysis patients. Systolic dysfunction had a prevalence rate of 26% by endoFS and of 48% by mwFS. During the follow-up period, 125 patients had one or more fatal and nonfatal CV events. On multivariate COX regression analysis, the three LV systolic function indicators were independently associated with incident fatal and nonfatal CV events, and there were no differences in the predictive power of these indicators (P > 0.30). The prediction power of LV function indicators was largely independent of traditional and novel risk factors in ESRD such as C-reactive protein and asymmetric dimethyl arginine (ADMA). ADMA was significantly related with LV function indicators as well as with mortality and incident CV events, but these links were much reduced (P = NS) in models including LV function indicators. Of note, the risk of CV events was minimal in patients with normal LV mass and function, intermediate in patients with either LVH or systolic dysfunction, and maximal in patients displaying both alterations. The study of myocardial contractility by echocardiography provides prognostic information independently of LV mass and other risk factors in ESRD. Risk stratification by simple systolic function parameters may prove useful in secondary prevention strategies in these patients.

Original languageEnglish (US)
Pages (from-to)1029-1037
Number of pages9
JournalJournal of the American Society of Nephrology
Volume15
Issue number4
DOIs
StatePublished - Apr 2004
Externally publishedYes

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Left Ventricular Function
Dialysis
Chronic Kidney Failure
Arginine
Echocardiography
Secondary Prevention
C-Reactive Protein
Cohort Studies
Heart Failure
Regression Analysis
Prospective Studies
Mortality

ASJC Scopus subject areas

  • Nephrology

Cite this

Prognostic Value of Echocardiographic Indicators of Left Ventricular Systolic Function in Asymptomatic Dialysis Patients. / Zoccali, Carmine; Benedetto, Francesco A.; Mallamaci, Francesca; Tripepi, Giovanni; Giacone, Giuseppe; Cataliotti, Alessandro; Seminara, Giuseppe; Stancanelli, Benedetta; Malatino, Lorenzo S.

In: Journal of the American Society of Nephrology, Vol. 15, No. 4, 04.2004, p. 1029-1037.

Research output: Contribution to journalArticle

Zoccali, C, Benedetto, FA, Mallamaci, F, Tripepi, G, Giacone, G, Cataliotti, A, Seminara, G, Stancanelli, B & Malatino, LS 2004, 'Prognostic Value of Echocardiographic Indicators of Left Ventricular Systolic Function in Asymptomatic Dialysis Patients', Journal of the American Society of Nephrology, vol. 15, no. 4, pp. 1029-1037. https://doi.org/10.1097/01.ASN.0000117977.14912.91
Zoccali, Carmine ; Benedetto, Francesco A. ; Mallamaci, Francesca ; Tripepi, Giovanni ; Giacone, Giuseppe ; Cataliotti, Alessandro ; Seminara, Giuseppe ; Stancanelli, Benedetta ; Malatino, Lorenzo S. / Prognostic Value of Echocardiographic Indicators of Left Ventricular Systolic Function in Asymptomatic Dialysis Patients. In: Journal of the American Society of Nephrology. 2004 ; Vol. 15, No. 4. pp. 1029-1037.
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AU - Tripepi, Giovanni

AU - Giacone, Giuseppe

AU - Cataliotti, Alessandro

AU - Seminara, Giuseppe

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