scholarly journals P246 Exercise E/e refines diagnosis of diastolic impairment in patients with chronic kidney disease

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
G Gan ◽  
K Kadappu ◽  
A Bhat ◽  
F Fernandez ◽  
H Chen ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Exercise Capacity ◽  
Mitral Annulus ◽  
Left Ventricular ◽  
Exercise Stress ◽  
Total N ◽  
Metabolic Equivalents ◽  
Mitral Annulus Velocity ◽  
The Relationship

Abstract Background Diastolic dysfunction is common in chronic kidney disease (CKD) patients and is associated with reduced exercise capacity. The ratio of early diastolic mitral inflow velocity to early diastolic mitral annulus velocity (E/e’) correlates with invasively measured left ventricular pressures, both at rest and during exercise. The aim of our study was to evaluate the relationship of resting and exercise E/e’ to exercise capacity in patients with stage 3 and 4 CKD. Methods CKD patients were prospectively recruited. All patients were required to be in sinus rhythm, without previous cardiac disease and with normal LVEF. The E/e’ ratio was assessed at rest and patients were stratified into 3 groups based on conventional clinical classifications (normal: ≤8, indeterminate: 8-14, raised: >14). Patients then underwent a symptom limited exercise stress echocardiogram whereby patients with resting E/e’ <14 additionally had post exercise E/e’ measured. Exercise capacity was assessed as metabolic equivalents (METs). A raised exercise E/e’ was defined as exercise E/e’ of ≥13. Lastly, we grouped patients based on abnormalities of baseline and exercise E/e’ (resting E/e’<14 & exercise E/e’<13, resting E/e’<14 & exercise E/e ≥13, resting E/e’ ≥14) and the relationship to METs achieved was evaluated. Results The cohort consisted of 156 CKD patients (62.8 ± 10.6 yrs, male 62%). 85% had hypertension and 39% had diabetes mellitus. 52/156 (34%) CKD patients had resting E/e’ of ≥14. Of the 104/156 (66%) CKD patients with normal/indeterminate resting E/e’, 66/104(63%) had normal exercise E/e’ <13 whilst 38/104(37%) had exercise E/e’ ≥13. Patients with resting E/e" & raised exercise E/e’ ≥13 achieved significantly lower METs compared to CKD patients with resting E/e’ <14 & exercise E/e’ <13 (5.0 ± 2.2 vs 8.8 ± 2.5, p< 0.01). Of note, METs achieved in this group were comparable to that achieved by CKD patients with raised resting E/e’ ≥ 14 (5.0 ± 2.2 METs vs 5.3 ± 2.6 METs, p = 0.55). Conclusion In CKD patients with normal/indeterminate resting E/e’, there is utility in performing exercise E/e’, which was increased in 37% of patients. Raised exercise E/e’ is associated with poorer exercise capacity and is a potential tool to refine diastolic abnormalities in patients with CKD. Group Total (n,%) METs Achieved Exercise Duration (minutes) Resting E/e’ ≤ 14 & Exercise E/e’ ≤ 13 66/156 (42%) 8.8 ± 2.5 8.4 ± 3.1 Resting E/e’ ≤ 14 & Exercise E/e’ ≥ 13 38/156 (24%) 5.0 ± 2.2 6.0 ± 3.1 Resting E/e’ ≥ 14 52/156 (34%) 5.3 ± 2.6 5.6 ± 2.2

scholarly journals 1679 E/e predicts exercise capacity and adverse cardiovascular outcomes in patients with chronic kidney disease

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
G Gan ◽  
K Kadappu ◽  
A Bhat ◽  
F Fernandez ◽  
H Chen ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Exercise Capacity ◽  
Strong Predictor ◽  
Cardiovascular Death ◽  
Left Ventricular ◽  
Exercise Stress ◽  
Major Adverse Cardiovascular Events ◽  
Metabolic Equivalents

Abstract Funding Acknowledgements Nil OnBehalf NA Background Patients with chronic kidney disease(CKD) have reduced physical fitness that contributes to the disproportionately elevated risk of cardiovascular disease in this population. Our aim was to assess the association between E/e’ and exercise capacity in CKD patients and the prognostic role of E/e’. Methods Patients with Stage 3/4 CKD, without previous cardiac disease were prospectively recruited. Recruited patients underwent transthoracic echocardiogram and exercise stress echocardiogram with assessment of exercise E/e’. Patients were compared, one to one, to age, gender and risk factor matched controls and were followed annually for 5 years for cardiovascular death and major adverse cardiovascular events (MACE). Exercise capacity was assessed as metabolic equivalents (METs) with reduced exercise capacity defined as METS of ≤7. Raised exercise E/e’ was defined as exercise E/average e’ of >13. Results 156 CKD patients (62.8 ± 10.6 yrs, male 62%) were compared to 156 matched controls. CKD patients had higher rates of anemia (p < 0.01), larger left ventricular indexed mass (p < 0.01), larger LAVI (p < 0.01) and higher resting (p < 0.01) and exercise E/e’ (p < 0.01). Overall, CKD patients achieved lower METs (p < 0.01) with exercise and a greater proportion of CKD patients had METs ≤7 (p < 0.01). Receiver operating curves (Figure1) showed exercise E/e’ (AUC 0.89, CI 0.84-0.95, p < 0.01) to be the strongest predictor of reduced exercise capacity in CKD patients. Exercise E/e’ of >13 was also associated with higher rates of cardiovascular death and MACE amongst CKD patients. Conclusion Exercise E/e’ is a strong predictor of exercise capacity amongst CKD patients, who commonly have reduced exercise capacity presumably consequent to diastolic dysfunction. Raised exercise E/e’ in CKD patients is predictor of cardiovascular death and MACE. Abstract 1679 Figure.

scholarly journals Left Atrial Reservoir Strain by Speckle Tracking Echocardiography: Association With Exercise Capacity in Chronic Kidney Disease

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Gary C.H. Gan ◽  
Aditya Bhat ◽  
Henry H.L. Chen ◽  
Kennith H. Gu ◽  
Fernando Fernandez ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Exercise Capacity ◽  
Left Atrial ◽  
Area Under The Curve ◽  
Left Ventricular ◽  
Exercise Stress ◽  
Ventricular Performance ◽  
Metabolic Equivalents ◽  
Echocardiographic Parameters

Background Left atrial (LA) function plays a pivotal role in modulating left ventricular performance. The aim of our study was to evaluate the relationship between resting LA function by strain analysis and exercise capacity in patients with chronic kidney disease (CKD) and evaluate its utility compared with exercise E/e'. Methods and Results Consecutive patients with stage 3 and 4 CKD without prior cardiac history were prospectively recruited from outpatient nephrology clinics and underwent clinical evaluation and resting and exercise stress echocardiography. Resting echocardiographic parameters including E/e' and phasic LA strain (LA reservoir [LASr], conduit, and contractile strain) were measured and compared with exercise E/e'. A total of 218 (63.9±11.7 years, 64% men) patients with CKD were recruited. Independent clinical parameters associated with exercise capacity were age, estimated glomerular filtration rate, body mass index, and sex ( P <0.01 for all), while independent resting echocardiographic parameters included E/e', LASr, and LA contractile strain ( P <0.01 for all). Among resting echocardiographic parameters, LASr demonstrated the strongest positive correlation to metabolic equivalents achieved (r=0.70; P <0.01). Receiver operating characteristic curves demonstrated that LASr (area under the curve, 0.83) had similar diagnostic performance as exercise E/e' (area under the curve, 0.79; P =0.20 on DeLong test). A model combining LASr and clinical metrics showed robust association with metabolic equivalents achieved in patients with CKD. Conclusions LASr, a marker of decreased LA compliance is an independent correlate of exercise capacity in patients with stage 3 and 4 CKD, with similar diagnostic value to exercise E/e'. Thus, LASr may serve as a resting biomarker of functional capacity in this population.

Abstract 12992: LA Strain Predicts Exercise Capacity in Chronic Kidney Disease

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Gary Gan ◽  
Aditya Bhat ◽  
Henry H.L. Chen ◽  
Kennith Gu ◽  
Fernando Fernandez ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Exercise Capacity ◽  
Predictive Value ◽  
Strain Analysis ◽  
Left Ventricular ◽  
Exercise Stress ◽  
Clinical Predictors ◽  
Predictive Capacity ◽  
Ventricular Performance

Background: Left atrial (LA) function plays a pivotal role in modulating left ventricular performance particularly during exercise. The aim of our study was to evaluate the relationship between resting LA function by strain analysis as a determinant of exercise capacity in chronic kidney disease (CKD) patients, and evaluate its utility compared to exercise E/e’. Methods: Consecutive Stage 3 and 4 CKD patients without prior cardiac history were prospectively recruited from outpatient nephrology clinics and underwent clinical evaluation, resting and exercise stress echocardiography. Patients needed to be in sinus rhythm without significant valvular disease or ischaemia on stress testing. Resting echocardiographic parameters including E/e’ and phasic LA strain [LA reservoir (LASr), conduit (LAScd) and contractile (LASct) strain] were measured and compared to exercise E/e’. Results: 218 (63.9±11.7yrs, 64% men) CKD patients were recruited. Independent clinical predictors of exercise capacity were age, eGFR, body mass index and gender (p<0.01 for all) while independent resting echocardiographic predictors included E/e’, LASr and LASct (p<0.01 for all). Amongst independent resting echocardiographic predictors, LASr ( r =0.70,p<0.01) demonstrated the strongest correlation to METs achieved. Receiver operating characteristic curves (Figure 1) demonstrated that LASr (AUC 0.83,) had similar predictive value as exercise E/e’ (AUC 0.79; AUC difference of 0.05, p=0.20 on DeLong test). A model combining LASr and clinical metrics showed robust predictive capacity for METs achieved in CKD patients. Conclusions: LASr, a marker of decreased LA compliance is an independent predictor of exercise capacity in Stage 3 and 4 CKD patients, with similar predictive value to exercise E/e’. The use of LASr may serve as a resting biomarker of functional capacity in this population.

scholarly journals Atherosclerotic vascular disease is more prevalent among black ESKD patients on long-term CAPD in South Africa

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
S. O. Oguntola ◽  
M. O. Hassan ◽  
R. Duarte ◽  
A. Vachiat ◽  
P. Manga ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Vascular Disease ◽  
Left Ventricular ◽  
Atherosclerotic Vascular Disease ◽  
Ckd Stage ◽  
Significant Difference ◽  
Echocardiographic Parameters ◽  
Relationship Of ◽  
The Relationship

Abstract Background Occurrence of cardiovascular disease (CVD) in the setting of chronic kidney disease (CKD) can be described as a “cruel alliance”, with CVD responsible for about half of all deaths among CKD patients. Chronic kidney disease patients are more likely to die from CVD than progress to end stage kidney disease (ESKD). Dyslipidaemia, a known traditional risk factor for CVD, is highly prevalent among CKD patients and with an even higher frequency among ESKD patients on dialytic therapies. Prolonged exposure of continuous ambulatory peritoneal dialysis (CAPD) patients to high glucose concentrations in CAPD fluid have been associated with increased risk of cardiovascular events. In this study, we investigated the relationship of atherosclerotic vascular disease (AsVD) to clinical and echocardiographic parameters among black South Africans with CKD (stage 3) and ESKD on CAPD and haemodialysis (HD). Methods This was a cross-sectional study of 40 adult (18–65 years) non-diabetic CKD patients (kidney disease outcome quality initiative [KDOQI] stage 3), 40 ESKD patients on CAPD, 40 ESKD patients on HD and 41 age and sex-matched healthy controls. An interviewer-administered questionnaire was used to obtain information on participants’ sociodemographic and cardiovascular risk factors. Anthropometric parameters were measured. Serum blood samples were analysed for creatinine, albumin and lipid profile; lipoprotein ratios, Framingham’s risk score and the 10-year risk of developing coronary heart disease (CHD) were calculated. Echocardiography was performed on all patients and carotid intima media thickness (CIMT) was measured in both right and left carotid arteries at 1 cm proximal to the carotid bulb. Spearman’s rank correlation and binary logistic regression were conducted to determine the relationship of AsVD to clinical and echocardiographic parameters. Results Atherosclerotic vascular disease was most prevalent among ESKD patients on CAPD (70%, n = 28/40). Chronic kidney disease and HD patients exhibited a similar prevalence (47.5%, n = 19/40), while the prevalence in controls was 17.1% (n = 7/41). Presence of AsVD was associated with significantly older age, higher waist hip ratio (WHR), left ventricular mass index (LVMI) and Framingham’s 10-year risk of developing CHD. Significant differences in clinical and echocardiographic parameters were observed when the study groups were compared. Age and LVH independently predicted AsVD. Conclusion Atherosclerotic vascular disease was more prevalent among CAPD patients compared to pre-dialysis CKD and HD patients. Among all lipoprotein ratios assessed, non-HDL-C showed the most consistent significant difference between the groups. Age (> 40 years) and presence of LVH were independent predictors of AsVD.

scholarly journals Correlation Between Thyroid Autoantibodies and Cardiovascular Disease in Patients With Stages 3-5 Chronic Kidney Disease

2021 ◽  
Author(s):  
Weicheng Xu ◽  
Shiyi Liang ◽  
Ge qian ◽  
Chijian Li ◽  
Yuxiang Huang ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Chronic Kidney Disease ◽  
Mitral Valve ◽  
Kidney Disease ◽  
Flow Velocity ◽  
Mitral Annulus ◽  
Thyroid Autoantibodies ◽  
Female Patients ◽  
Early Diastole ◽  
Mitral Annulus Velocity

Abstract Background: Chronic kidney disease (CKD) interacts with thyroid disease and cardiovascular disease (CVD). Our research aimed to analyze the correlation between echocardiographic parameters E / A, E / E ', E' / A ', LVEF and thyroid autoantibodies, and evaluate the role of thyroid autoimmunity in the development of CVD in patients with stages 3-5 CKD.Methods: The patients who were diagnosed as stages 3-5 CKD in our department from January 2015 to May 2019 were recruited. We collected the routine medical history, general clinical data, and laboratory test index of patients. Echocardiography is performed by a trained echocardiographer to measure mitral valve blood flow velocity (E) in early diastole and Mitral valve flow velocity (A), E / A ratio, mitral annulus velocity (E ') in early diastole, mitral annulus velocity (A') in end-diastole, E / E 'ratio, and E' / A ' ratio. The SPSS 22.0 statistical software was used to analyze the data.Results: A total of 1164 patients with stages 3-5 CKD were included. Thyroglobulin antibody (TGAb) was negatively correlated with eGFR (r = -0.287, P <0.05). Thyrotropin receptor antibody (TRAb) was significantly positively correlated with CRP (r = 0.206, P <0.001). The titers of TPOAb and TGAb in male diabetic patients were higher (r = 0.137, P = 0.023; r = 0.159, P = 0.011). In female patients, both TPOAb and TGAb are significantly negatively correlated with HGB (r = -0.213, P = 0.018; r = -0.188, P = 0.019). The E / E’ of patients with TPOAb positive was higher (r = 0.181, P ＜ 0.001). The LVEF in patients with TPOAb positive were higher (r = 0.159, P = 0.007). In addition, LVEF was significantly negatively correlated with TRAb (r = -0.112, P = 0.026).Conclusion: The prevalence of AITD in stages 3-5 CKD gradually increases with the decline of renal function, and the titers of TPOAb and TGAb also gradually increase. In patients with stages 3-5 CKD, AITD may accelerate the incidence of CVD in CKD patients by affecting TG levels, accelerating the occurrence of anemia, and promoting the micro-inflammation. Female patients with high titers of TPOAb and TGAb should be paid more attention. The average E/E' of patients with stage 5 CKD was 16. Women with low FT3 and TPOAb positive maybe more likely to develop diastolic heart failure.

Ratio of Transmitral E-Wave Velocity to Early Diastole Mitral Annulus Velocity with Cardiovascular and Renal Outcomes in Chronic Kidney Disease

2013 ◽  
Vol 123 (1-2) ◽  
pp. 52-60 ◽  
Author(s):  
Szu-Chia Chen ◽  
Jer-Ming Chang ◽  
Yi-Chun Tsai ◽  
Jiun-Chi Huang ◽  
Ling-I Chen ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Wave Velocity ◽  
Mitral Annulus ◽  
Renal Outcomes ◽  
Early Diastole ◽  
Mitral Annulus Velocity

Abstract P295: Exercise Capacity and Rate of Progression to Chronic Kidney Disease

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Peter Kokkinos ◽  
Apostolos Tsimploulis ◽  
Charles Faselis ◽  
Jonathan Myers ◽  
Jiajia Zhang ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Exercise Capacity ◽  
Proportional Hazards ◽  
Reference Group ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Exercise Stress ◽  
Rate Of Progression

Introduction: Increased exercise capacity is associated with better health outcomes. It is not known if increased fitness can attenuate the progression to chronic kidney disease (CKD). Hypothesis: We assessed the hypothesis that increased exercise capacity is associated inversely with the rate of progression to CKD. Methods: A routine exercise stress was performed on 6,452 veterans (mean age: 58±12) with normal kidney function at VA Medical Centers in Washington DC. We used Cox proportional hazards model with spline function of MET to define the MET level associated with no increase in rate of progression to CKD (hazard ratio (HR)=1.0). We used this MET level to guide the formation of the following four fitness categories based on intervals of 2 METs achieved above and below this threshold: Least-Fit (<5.5 METs; n=1,392); Low-Fit (5.5-7.5 METs; n=2,270); Moderate-Fit (7.6-9.5 METs; n=2,192) and High-Fit (>9.5 METs; n=714). We then performed Cox proportional hazards analysis adjusted for age, BMI, cardiac risk factors, sleep apnea, alcohol dependence and medications. We used the Least-fit category as the reference group. Results: The MET threshold for the entire cohort was defined at 7.5 METs. During the follow-up period (median 8.8 years; 50,371 person-years of follow-up), 925 individuals developed CKD based on an estimated glomerular filtration rate <60 ml/min/1.73m 2 . Cox proportional hazards analysis revealed that exercise capacity was inversely associated with the rate of progression to CKD. More specifically, the rate of progression was lower by 25% (HR=0.75; CI: 0.64-0.87; p<0.001) for Low-Fit individuals, 40% (HR=0.60; CI: 0.48-0.73; p<0.001) for the Moderate-Fit and 68% (HR=0.42; CI: 0.28-0.64; p<0.001) for High-Fit individuals. Conclusions: Exercise capacity is inversely associated with the rate of progression to CKD.

Biochemical and Paraclinical Evaluation of Organ Damage in Arterial Hypertension with Associated Chronic Kidney Disease

2020 ◽  
Vol 71 (6) ◽  
pp. 194-204
Author(s):  
Teim Baaj ◽  
Ahmed Abu-Awwad ◽  
Mircea Botoca ◽  
Octavian Marius Cretu ◽  
Elena Ardeleanu ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Cardiovascular Risk ◽  
Kidney Disease ◽  
Ventricular Hypertrophy ◽  
Ankle Brachial Index ◽  
Intima Media Thickness ◽  
Organ Damage ◽  
Left Ventricular ◽  
Study Group ◽  
Group A

Organ damages, which contribute to the overall cardiovascular risk of hypertensive patients, should be early detected, prevented and treated. The study evaluated organ damage in a hypertensive study group with chronic kidney disease (CKD), compared with a study group of hypertension without CKD. Albuminuria was present in 41.2% and reduced estimated glomerular filtration rate [60 ml/min/m2 was present in 72.5% of hypertensive with CKD. The comparison of organ damage revealed in the CKD group a statistical significant higher prevalence of organ damage as follows: intima-media thickness ]0.9 mm in 39.9% vs 10.5%, carotid plaques in 28.2% vs 12.6%, left ventricular hypertrophy in 39.9% vs 31%, ankle brachial index in 6.2% vs 3.5%. Early detection and treatment of additional cardiovascular risk factors as dyslipidaemia and hyperglycaemia, that have significant role in the pathogenesis of organ damage, contribute to the better prevention of cardiovascular and renal complications in hypertension with CKD.

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