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Subclinical markers of cardiovascular disease predict adverse outcomes in chronic kidney disease patients with normal left ventricular ejection fraction

View Article: PubMed Central - PubMed

ABSTRACT

Emerging cardiovascular biomarkers, such as speckle tracking echocardiography (STE) and aortic pulse wave velocity (aPWV), have recently demonstrated the presence of subclinical left ventricular dysfunction and arterial stiffening in patients with chronic kidney disease (CKD) and no previous cardiovascular history. However, limited information exists on the prognostic impact of these biomarkers. We aimed to investigate whether STE and aPWV predict major adverse cardiac events (MACE) in this patient population. In this cohort study we prospectively analysed 106 CKD patients with no overt cardiovascular disease (CVD) and normal left ventricular ejection fraction. Cardiac deformation was measured using STE while aPWV was measured using arterial tonometry. The primary end-point was the composite of all-cause mortality, acute coronary syndrome, stable angina requiring revascularization (either using percutaneous coronary intervention or coronary artery bypass surgery), hospitalization for heart failure and stroke. Over a median follow up period of 49 months (interquartile range 11–63 months), 26 patients (24.5%) reached the primary endpoint. In a multivariable Cox hazards model, global longitudinal strain (GLS) (HR 1.12, 95% CI 1.02–1.29, p = 0.041) and aPWV (HR 1.31, 95% CI 1.05–1.41, p = 0.021) were significant, independent predictors of MACE. GLS and aPWV independently predict MACE in CKD patients with normal EF and no clinically overt CVD.

No MeSH data available.


Event free survival according GLS (upper graph) and aPWV (lower graph) cut−off values. Kaplan–Meier time to primary endpoint curves stratified according to a GLS and aPWV of −17.7% and 10.2 m/s respectively. Patients with GLS more then (less negative) −17.7% and aPWV more than 10.2 m/s were more likely to reach a primary endpoint at a median follow up of 49 months ± 9 months when compared with those with a GLS less then (more negative) −17.7% and aPWV of less then 10.2 m/s
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Fig3: Event free survival according GLS (upper graph) and aPWV (lower graph) cut−off values. Kaplan–Meier time to primary endpoint curves stratified according to a GLS and aPWV of −17.7% and 10.2 m/s respectively. Patients with GLS more then (less negative) −17.7% and aPWV more than 10.2 m/s were more likely to reach a primary endpoint at a median follow up of 49 months ± 9 months when compared with those with a GLS less then (more negative) −17.7% and aPWV of less then 10.2 m/s

Mentions: From all the imaging parameters, we found that GLS with a cut-off value of −17.7% (72.3% sensitivity, 70.3% specificity), and aPWV with a cut-off value of 10.2 m/s (76.1% sensitivity and 69.6% specificity) had the best discriminatory power to predict the occurrence of the primary outcome (Table 3). Furthermore, patients with a GLS greater than −17.7% (log rank p = 0.027) and aPWV of 10.2 m/s or more (log rank p = 0.019) had a reduced estimated MACE free survival at 49 months follow up (Fig. 3).


Subclinical markers of cardiovascular disease predict adverse outcomes in chronic kidney disease patients with normal left ventricular ejection fraction
Event free survival according GLS (upper graph) and aPWV (lower graph) cut−off values. Kaplan–Meier time to primary endpoint curves stratified according to a GLS and aPWV of −17.7% and 10.2 m/s respectively. Patients with GLS more then (less negative) −17.7% and aPWV more than 10.2 m/s were more likely to reach a primary endpoint at a median follow up of 49 months ± 9 months when compared with those with a GLS less then (more negative) −17.7% and aPWV of less then 10.2 m/s
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5383685&req=5

Fig3: Event free survival according GLS (upper graph) and aPWV (lower graph) cut−off values. Kaplan–Meier time to primary endpoint curves stratified according to a GLS and aPWV of −17.7% and 10.2 m/s respectively. Patients with GLS more then (less negative) −17.7% and aPWV more than 10.2 m/s were more likely to reach a primary endpoint at a median follow up of 49 months ± 9 months when compared with those with a GLS less then (more negative) −17.7% and aPWV of less then 10.2 m/s
Mentions: From all the imaging parameters, we found that GLS with a cut-off value of −17.7% (72.3% sensitivity, 70.3% specificity), and aPWV with a cut-off value of 10.2 m/s (76.1% sensitivity and 69.6% specificity) had the best discriminatory power to predict the occurrence of the primary outcome (Table 3). Furthermore, patients with a GLS greater than −17.7% (log rank p = 0.027) and aPWV of 10.2 m/s or more (log rank p = 0.019) had a reduced estimated MACE free survival at 49 months follow up (Fig. 3).

View Article: PubMed Central - PubMed

ABSTRACT

Emerging cardiovascular biomarkers, such as speckle tracking echocardiography (STE) and aortic pulse wave velocity (aPWV), have recently demonstrated the presence of subclinical left ventricular dysfunction and arterial stiffening in patients with chronic kidney disease (CKD) and no previous cardiovascular history. However, limited information exists on the prognostic impact of these biomarkers. We aimed to investigate whether STE and aPWV predict major adverse cardiac events (MACE) in this patient population. In this cohort study we prospectively analysed 106 CKD patients with no overt cardiovascular disease (CVD) and normal left ventricular ejection fraction. Cardiac deformation was measured using STE while aPWV was measured using arterial tonometry. The primary end-point was the composite of all-cause mortality, acute coronary syndrome, stable angina requiring revascularization (either using percutaneous coronary intervention or coronary artery bypass surgery), hospitalization for heart failure and stroke. Over a median follow up period of 49 months (interquartile range 11–63 months), 26 patients (24.5%) reached the primary endpoint. In a multivariable Cox hazards model, global longitudinal strain (GLS) (HR 1.12, 95% CI 1.02–1.29, p = 0.041) and aPWV (HR 1.31, 95% CI 1.05–1.41, p = 0.021) were significant, independent predictors of MACE. GLS and aPWV independently predict MACE in CKD patients with normal EF and no clinically overt CVD.

No MeSH data available.