Diastolic function predicts survival after renal revascularization

Abstract

Purpose To define the relationship between left ventricular diastolic function and survival after renal revascularization. Methods 76 adult patients (49 women, 27 men; mean age: 63 years ± 13 years) with preoperative echocardiography who underwent renal revascularization for atherosclerotic disease were identified. Diastolic function was estimated from the early diastolic transmitral flow velocity (E), the atrial transmitral flow velocity (A) and the mitral annular tissue doppler velocity (e’). Patients were divided into two groups of diastolic dysfunction as either none/mild (E/A≤0.75, E/e’<10) or moderate/severe (E/A>0.75, E/e’≥10). Perioperative and follow-up mortality were determined from a prospective vascular database and the National Death Index. Descriptive statistics were calculated. Postoperative survival was estimated by product-limit methods. Associations between preoperative factors, perioperative factors and follow-up survival were examined using proportional hazards regression models. A forward stepwise variable selection procedure was used to select a ‘best’ model to predict follow-up survival. Results 76 patients were followed for an average of 41.9 months after renal revascularization. Within this group 47/76 (61.8%) patients were identified as having moderate or severe diastolic dysfunction. Diastolic dysfunction had no apparent association with abnormal systolic function. The mean ejection fraction for those with moderate/severe diastolic dysfunction was 57.7% +/− 11.5%. When comparing the moderate/severe and none/mild groupings of diastolic dysfunction, there was a significant difference in left ventricular mass index (151.9 +/− 48.9 vs. 125.3 +/− 31.7, P = .0087). There were 5 deaths in the perioperative period and 20 deaths on follow-up. Among perioperative survivors, hypertension was cured or improved in 82% of the none/mild group and 53% of the moderate/severe group (P = .012). In multivariable analysis, none/mild diastolic dysfunction was significantly and independently associated with an improvement in blood pressure after revascularization (OR 6.2, 95% CI 1.4-28.6, P = .018). Ejection fraction was not associated with survival. After forward variable selection, moderate/severe diastolic dysfunction (HR 5.8, 95% CI 1.4–25, P = .018) was the only variable to demonstrate a significant and independent association with follow-up survival. Conclusion Diastolic dysfunction, but not systolic dysfunction, was frequent in patients with renovascular disease. Blood pressure response and follow-up survival after renal revascularization demonstrated significant and independent associations with diastolic function. Consideration of diastolic function should be included in the management of patients with atherosclerotic renovascular disease.

Concomitant coronary and renal revascularization improves left ventricular hypertrophy more than coronary stenting alone in patients with ischemic heart and renal disease

“…Improved coronary circulation could contribute to the balance between myocardial energy requirements and oxygen supply, and relief of myocardial stiffness. A previous cohort study had demonstrated that diastolic function was significantly and independently associated with BP response and follow-up survival in patients undergoing open renal revascularization (Ghanami et al, 2011). The extent of systolic BP improvement in our study was more significant in the HFpEF-I group than in the HFpEF-II group.…”