• Cardiac Imaging Techniques
• Imaging Modalities Clinical Trials

R. Rodriguez, MBBS, San Fernando General Hospital, San Fernando, Trinidad and Tobago, presented the results of a study that showed no strong correlation between transthoracic echocardiographic measurements at the commencement of hemodialysis and mortality at 1 year.

The study involved a retrospective chart review of all patients (n=40; mean age 52 years) who began hemodialysis between January 1, 2008 and December 1, 2009 at San Fernando General Hospital. The objective was to determine whether echocardiography provided any findings that were predictive of mortality. Mortality at 12 months and the presence of diabetes mellitus, hypertension, and other risk factors were documented. The following echocardiographic parameters were assessed: left ventricular diastolic and systolic diameter (LVIDd and LVIDs), left atrial diameter (LAD), interventricular septal diameter (IVDS), left ventricular posterior wall diameter (LVPWd), and ejection fraction (EF).

The 12-month mortality rate was 57.5%. Thirty (75%) patients had diabetes mellitus, 33 (82.5%) had hypertension, 30 patients (72%) had both diabetes mellitus and hypertension, and 9 (22.5%) had other risk factors. Most patients (80%) had 2 risk factors. Echocardiographic parameters are shown in Table 1.

Although no strong correlation was observed between echocardiographic parameters and mortality for the entire population, when data for patients who died within 12 months were analyzed separately, the correlations of 1-year mortality and LVIDd (r²=0.05) and LAD (r²=0.04) were improved. There were no other important changes in the relationship with other echocardiographic parameters.

Although limited by its small size, this study suggests that hypertension is the most common comorbidity in patients with end-stage renal failure who commence hemodialysis at the San Fernando General Hospital. This modestly sized study was notable for a very high rate of mortality and a low proportion of patients with severe left ventricular function, an echocardiographic characteristic that has been clearly associated with outcomes in the existing literature. The authors note that other, potentially correctable factors may be responsible for the high 12-month mortality that was seen in this study and merit further investigation. While these preliminary findings require validation, they do raise the question of whether routine transthoracic echocardiography in patients who commence hemodialysis is useful in predicting subsequent mortality.

• © 2011 MD Conference Express