Parameters derived from myocardial tissue Doppler imaging associated with major events in patients with uremia

Background: High cardiovascular mortality in uremic patients is still a problem. This study was designed to assess some echocardiographic parameters to predict prognosis. Methods: We enrolled 95 patients (19 with coronary arterial disease). All underwent conventional echocardiography and tissue Doppler imaging within 30 minutes before and after hemodialysis (H/D). We measured the ratio of the early-diastolic velocity of mitral inflow (E) to the early-diastolic velocity of the mitral annulus (Em). Patients received 4-year follow-up for major events (any-cause mortality and nonfatal cardiovascular events requiring hospitalization). Results: Thirteen deaths and 11 nonfatal major events occurred. The prevalence of underlying coronary arterial disease was higher in patients with major events than in others (33% vs. 7%), as was the degree of left ventricular (LV) systolic dysfunction (LV ejection fraction 46% ± 10 vs. 52% ± 8). Baseline E/Em, either pre-dialytic or post-dialytic, was significantly lower in event-free patients (pre-dialytic 9.9 ± 3.0 vs. 12.2 ± 4.0, p = 0.01; post-dialytic 9.2 ± 2.9 vs. 12.3 ± 3.6, p = 0.002). On Cox regression, factors significantly affecting outcomes were age, LV ejection fraction, LV mass index (hazard ratio [HR] = 1.021, 95% confidence interval [CI] 1.001-1.039, p = 0.021), and post-dialytic E/Em ≥12 (HR = 3.054, 95% CI 1.118-11.184, p = 0.009). Conclusion: Like LV dysfunction and LV mass index, a high post-dialytic E/Em was prognostic of major events.