Clinical significance of central systolic blood pressure in LV diastolic dysfunction and CV mortality

Abstract

Background and aims: Cardiovascular (CV) disease is the major cause of death in patients with end-stage kidney disease (ESKD). Left ventricular (LV) diastolic dysfunction reflects LV pressure overload and is common in patients with ESKD. Recently, there have been studies on the usefulness of central blood pressure (BP); however, the relationship between central BP and LV diastolic dysfunction is not clear in dialysis patients with preserved systolic function. The purpose of this study was to investigate the clinical implication of central BP on LV diastolic dysfunction and CV mortality in the ESKD patients with preserved LV systolic function.

Methods: This prospective observational cohort study investigated the effect of LV diastolic dysfunction on CV mortality in the ESKD patients with preserved systolic function using echocardiography. Vascular calcification was evaluated using the abdominal aortic calcification score, and aortic stiffness was determined by measuring pulse wave velocity (PWV). The predictors of CV mortality were analyzed using Cox proportional hazard analysis.

Results: The subjects were comprised of 61 patients, with an average age of 54 years, 20 males (32.8%), and 25 diabetics (41.0%). There were 39 patients on hemodialysis and 22 patients receiving peritoneal dialysis treatment. During the mean follow-up period of 79.3 months, 16 patients (26.2%) died, and 7 patients (11.4%) died of CV events. The central systolic BP and diabetes were independent risk factors for LV diastolic dysfunction. In addition, patients with LV diastolic dysfunction had an increased CV mortality. When left atrial volume index and PWV were adjusted, the E/E' ratio was found to be a predictor of CV mortality.

Conclusions: Central systolic BP and diabetes were found to be significant risk factors for LV diastolic dysfunction. LV diastolic dysfunction can independently predict CV mortality in dialysis patients with preserved LV systolic function.

Fig 1. Kaplan-Meier survival curves for CV mortality according to LV diastolic dysfunction.

CV mortality was significantly higher in patients with LV diastolic dysfunction (log-rank test, p = 0.021).

Fig 2. A) Central systolic BP had positive correlation with E/E’ ratio (r = 0.441, p <0.001), B) Central systolic BP and LAVI had positive correlation (r = 0.394, p = 0.005).