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Left ventricular diastolic pressure gradient and outcome in advanced chronic kidney disease patients with preserved ejection fraction

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Abstract

Assessment of left ventricular (LV) diastolic dysfunction is important in patients with chronic kidney disease (CKD). The early diastolic peak intraventricular pressure gradient (IVPG) has a vital role in diastolic function. Relative pressure imaging (RPI) is a new echocardiographic method to quantify IVPG. The purpose of this study was to analyze RPI-derived IVPG in advanced CKD patients with preserved LV ejection fraction. The study population consisted of 51 advanced CKD patients and 39 healthy controls. Patients were stratified by the evidence of heart failure with preserved ejection fraction (HFpEF) into HFpEF group (32 patients) and non-HFpEF group (19 patients). RPI analysis was used to determine the early diastolic LV relative pressure and pressure distribution. The total IVPG and segmental IVPGs corresponding to basal, mid, and apical part of the LV were calculated. Total IVPG, along with apical and mid IVPGs were all significantly reduced in HFpEF Group compared with non-HFpEF Group and controls (all P < 0.05). But no significant difference of total or segmental IVPGs was found between non-HFpEF Group and the controls. Additionally, apical IVPG < 0.02 mmHg/cm (Hazard ratio 9.82, 95 % confidence interval 2.01−48.01, P = 0.005) was the independent risk factor for the composite outcome (mortality and cardiovascular hospitalization) during a median follow-up of 24 months. Advanced CKD patients with HFpEF exhibited decreased apical and mid IVPG of the LV, and the severity of apical IVPG reduction correlated with poor outcome.

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All data generated and analyzed in this study is available from the corresponding author on reasonable request.

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Acknowledgements

This study was supported by Post-Doctor Research Project, West China Hospital, Sichuan University (No. 19HXBH042), 1·3·5 project for disciplines of excellence-Clinical Research Incubation Project, West China Hospital, Sichuan University (No. 2020HXFH044), and Science & Technology Pillar Program of Sichuan Province (No. 2021YFS0333).

Funding

This study was supported by Post-Doctor Research Project, West China Hospital, Sichuan University (No. 19HXBH042), 1·3·5 project for disciplines of excellence-Clinical Research Incubation Project, West China Hospital, Sichuan University (No. 2020HXFH044), and Science & Technology Pillar Program of Sichuan Province (No. 2021YFS0333).

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Authors and Affiliations

  1. Department of Cardiology, West China Hospital of Sichuan University, 37 Guoxue Alley, Chengdu, 610041, Sichuan, China

    Yue Zhong, Yuyan Cai, Mei Liu, Wenjuan Bai, Fang Wang, Hong Tang & Li Rao

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  1. Yue Zhong
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  2. Yuyan Cai
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  3. Mei Liu
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  4. Wenjuan Bai
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  5. Fang Wang
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  6. Hong Tang
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  7. Li Rao
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Contributions

YZ drafted the manuscript. YZ, YC, ML and FW enrolled the participants and conducted the data analyses. WB and HT checked the analysis results. LR conceived the study design, revised the manuscript and performed the final approval of the version to be submitted. All authors reviewed the manuscript and gave their consents for publication.

Corresponding author

Correspondence to Li Rao.

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The authors declare no competing interests.

Ethical approval

The study protocol was approved by the Institutional Ethics Committee of West China Hospital of Sichuan University (Sichuan, China) for Medical Research, and performed according to the principles of the Declaration of Helsinki. All participants provided their written informed consents.

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Zhong, Y., Cai, Y., Liu, M. et al. Left ventricular diastolic pressure gradient and outcome in advanced chronic kidney disease patients with preserved ejection fraction. Int J Cardiovasc Imaging 37, 2663–2673 (2021). https://doi.org/10.1007/s10554-021-02339-4

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  • DOI: https://doi.org/10.1007/s10554-021-02339-4

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