Ratio of Transmitral E Wave Velocity to Left Atrial Strain as a Useful Predictor of Total and Cardiovascular Mortality in Hemodialysis Patients

Abstract

The ratio of transmitral E-wave velocity (E) to a left ventricular diastolic parameter is reported to be well correlated with left ventricular filling pressure and is useful in the prediction of mortality. Left atrial (LA) strain has been demonstrated to be associated with left ventricular diastolic function. The aim of the study is to examine the ability of E/LA strain in predicting total and cardiovascular mortality in hemodialysis (HD) patients. In 197 routine HD patients, global LA strain during the reservoir phase was estimated by taking the average of longitudinal strain data obtained from the apical four-chamber and two chamber views by two-dimensional speckle tracking echocardiography. Twenty-nine total mortality and 14 cardiovascular mortality were documented during the 2.7 ± 0.6-year follow-up. After adjusting age, comorbidities, albumin, E/early diastolic mitral annular velocity (Ea), and LA strain, increased E/LA strain (hazard ratio (HR) = 1.191, 95% confidence interval (CI) = 1.072−1.324, p = 0.001) was still associated with increased total mortality. After adjusting age, comorbidities, albumin, E/Ea, left ventricular ejection fraction, and LA strain, increased E/LA strain (HR = 1.195, 95% CI = 1.041−1.372, p = 0.011) was still associated with increased cardiovascular mortality. In conclusion, E/LA strain is a useful parameter in the prediction of total and cardiovascular mortality in HD patients. Hence, E/LA strain deserves to be calculated in HD patients for better survival prediction.

Left Ventricular Strain and Left Atrial Strain Are Impaired During Hemodialysis in Children

“…When combined with mitral in ow E velocity, the E/ res increased at mid-HD and remained increased at post-HD. The E/ res ratio has been identi ed as a useful parameter in the prediction of total and cardiovascular mortality in adult HD patients [20]. Similar to Ds, these LAS and Sr changes in our study were not associated with BV removal or BP change.…”

“…Left atrial strain is a sensitive marker of early diastolic dysfunction, linearly worsens to the progression of diastolic dysfunction, and improves as LV lling pressure improves [19]. While the use of LAS has been studied in HD adults and found to be predictive of outcome [20], we found no prior study assessing LAS in pediatric chronic HD. In our study, LAS and Sr during the atrial early emptying (conduit) and atrial lling (reservoir) were impaired at mid-HD but returned to baseline at the end of HD.…”

Increased risk of major depressive disorder in sleep apnea patients in Taiwan

“…Since March, 1995, the Taiwan NHI has covered ambulatory care, inpatient care, dental services, and prescription drugs with a coverage rate of more than 96% of whole population of about 23 million people 1 , 2 . The NHIRD, containing information about reimbursement claims in the NHI system, was managed by the Taiwan National Health Research Institutes and was released with encrypted identification of patients and healthcare providers for medical research.…”

“…The diagnosis of SA was identified using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes of 780.51, 780.53, and 780.57 1 – 4 . This method for identifying SA patients in the NHIRD has been validated in previous studies 1 , 21 – 23 . The dates of their first SA diagnosis were defined as their index dates.…”

“…Sleep apnea (SA) is the most common sleep disorder, which presents with repetitive cessation of breathing during sleep, usually associated with intermittent hypoxia, sleep fragmentation and daytime sleepiness 1 – 6 . The prevalence of SA, estimated by Wisconsin Sleep Cohort study, was higher in men than in women (24% and 9%, respectively) 7 .…”