Predictors of Increased Left Ventricular Filling Pressure in Dialysis Patients with Preserved Left Ventricular Ejection Fraction

Aim To study the left and right ventricular function and to assess the predictors of increased left ventricular (LV) filling pressure in dialysis patients with preserved LV ejection fraction. Methods This study included 63 consecutive patients (age 57 ± 14 years, 57% women) with end-stage renal failure. Echocardiography, including tissue Doppler measurements, was performed in all patients. Based on the median value of the ratio of transmitral early diastolic velocity to early myocardial velocity (E/E’ ratio), patients were divided into 2 groups: the group with high filling pressure (E/E’>10.16) and the group with low filling pressure (E/ E’≤10.16). Results Compared with patients with low filling pressure, the group of patients with high filling pressure included a higher proportion of diabetic patients (41% vs 13%, P = 0.022) and had greater LV mass index (211 ± 77 vs 172 ± 71 g/m3, P = 0.04), lower LV lateral long axis amplitude (1.4 ± 0.3 vs 1.6 ± 0.3 cm, P = 0.01), lower E wave (84 ± 19 vs 64 ± 18cm/s, P < 0.001), lower systolic myocardial velocity (S’: 8.6 ± 1. 5 vs 7.0 ± 1.3 cm/s, P < 0.001), and lower diastolic myocardial velocities (E’: 6.3 ± 1.9 vs 9.5 ± 2.9 cm/s, P < 0.001; A’: 8.4 ± 1.9 vs 9.7 ± 2.5 cm/s, P = 0.018). Multivariate analysis identified LV systolic myocardial velocity – S’ wave (adjusted odds ratio, 1.909; 95% confidence interval, 1.060-3.439; P = 0.031) and age (1.053; 1.001-1.108; P = 0.048) as the only independent predictors of high LV filling pressure in dialysis patients. Conclusions In dialysis patients with preserved left ventricular ejection fraction, reduced systolic myocardial velocity and elderly age are independent predictors of increased left ventricular filling pressure

Predictors of Increased Left Ventricular Filling Pressure in Dialysis Patients with Preserved Left Ventricular Ejection Fraction

Aim To study the left and right ventricular function and to assess the predictors of increased left ventricular (LV) filling pressure in dialysis patients with preserved LV ejection fraction. Methods This study included 63 consecutive patients (age 57 ± 14 years, 57% women) with end-stage renal failure. Echocardiography, including tissue Doppler measurements, was performed in all patients. Based on the median value of the ratio of transmitral early diastolic velocity to early myocardial velocity (E/E’ ratio), patients were divided into 2 groups: the group with high filling pressure (E/E’>10.16) and the group with low filling pressure (E/ E’≤10.16). Results Compared with patients with low filling pressure, the group of patients with high filling pressure included a higher proportion of diabetic patients (41% vs 13%, P = 0.022) and had greater LV mass index (211 ± 77 vs 172 ± 71 g/m3, P = 0.04), lower LV lateral long axis amplitude (1.4 ± 0.3 vs 1.6 ± 0.3 cm, P = 0.01), lower E wave (84 ± 19 vs 64 ± 18cm/s, P < 0.001), lower systolic myocardial velocity (S’: 8.6 ± 1. 5 vs 7.0 ± 1.3 cm/s, P < 0.001), and lower diastolic myocardial velocities (E’: 6.3 ± 1.9 vs 9.5 ± 2.9 cm/s, P < 0.001; A’: 8.4 ± 1.9 vs 9.7 ± 2.5 cm/s, P = 0.018). Multivariate analysis identified LV systolic myocardial velocity – S’ wave (adjusted odds ratio, 1.909; 95% confidence interval, 1.060-3.439; P = 0.031) and age (1.053; 1.001-1.108; P = 0.048) as the only independent predictors of high LV filling pressure in dialysis patients. Conclusions In dialysis patients with preserved left ventricular ejection fraction, reduced systolic myocardial velocity and elderly age are independent predictors of increased left ventricular filling pressure

ROUTINE PERCUTANEOUS CORONARY INTERVENTION VERSUS MEDICAL THERAPY IN CLINICAL PRACTICE: THE ISACS-TC REGISTRY

Background: The role of revascularization with percutaneous coronary intervention (PCI) in the management of Unstable Angina and Non-ST-Elevation Myocardial Infarction (UA/NSTEMI) remains controversial. Previous post hoc analysis of randomized clinical trials has shown that troponin elevation permits the determination of high-risk patients who may benefit more from PCI. We further explored this hypothesis in clinical practice, attempting to address previous concerns on baseline risk of patients as assessed by biomarker status (UA versus NSTEMI). Methods: The study population of the present analysis consists of the International Survey of Acute Coronary Syndromes in Transitional Countries (ISACS-TC/NCT01218776) registry participants. This is an observational study of 1940 UA/NSTEMI patients; of these 805 underwent routine PCI and 1135 received medical therapy (MT) alone. The primary outcome was all-cause in-hospital mortality. Results: Patients treated with MT alone included a greater number of females (37% versus 26.21%, p<0.001), had higher rates of cerebrovascular disease (7.22% versus 3.11%, p=0.0001), of diabetes (30.6% versus 21.53%, p<0.001) and Killip class 65 2 (21.10% versus 17.07%, p=0.1759), but lower rates of smoking (24.55% versus 40.30%, p<0.001) and hypercholesterolemia (42.76% versus 46.41%, p=0.1466) than their counterpart undergoing PCI. In multivariable regression analysis, in-hospital revascularization was independently associated with a reduction of the primary outcome when compared with MT: adjusted odd ratio (OR) 0.37 (95% confidence interval [CI]: 0.19\u20130.72, p=0.003] and 3.24 (95%CI 1.44 \u2013 7.30, p=0.004). Analysis restricted to patients with NSTEMI showed attenuation in the effect size for all-cause mortality: adjusted OR: 0.49 ; 95% CI: 0.25\u20130.96, p=0.037 and 2.32 (95% CI: 1.02 \u2013 5.29, p=0.045). Conclusions: Contrary to expectations, a routine strategy with PCI was associated with greater benefits in patients with negative troponin status ( UA). Potential clinical benefits from PCI do not seem to favorably affect the overall prognosis of the index myocardial infarction (NSTEMI). Larger randomized studies are required to prove this conclusively