Left Ventricular Diastolic Dysfunction across Levels of Kidney Function: A Cross-Sectional Study Based on Routine Clinical Practice Data.

ABSTRACT

Left ventricular diastolic dysfunction (LVDD) commonly coexists with kidney dysfunction. In this study, we investigated the presence of abnormalities in echocardiography parameters indicative of LVDD across stages of kidney function. Methods: We selected patients who visited a university hospital and had a serum creatinine and echocardiography reported in their medical records. Participants were categorized based on their kidney function normal (estimated glomerular filtration rate [eGFR] ≥ 90 mL/min/1.73 m2), mildly decreased (eGFR 60-90), moderately decreased (eGFR 30-60), and severely decreased (eGFR < 30). The relationship between kidney function and echocardiography parameters was examined using logistic and linear regressions. Results: Among 4022 patients (age 66.5 years [SD 12.1], 41% women), 26%, 50%, 20%, and 4% had a normal, mildly, moderately, and severely decreased kidney function, respectively. Compared to patients with normal kidney function, patients with mildly decreased kidney function had higher odds for an abnormal E/e' ratio (OR 1.51 [95% CI 1.13, 2.02]). Patients with moderately decreased kidney function presented a higher risk of abnormal E/e' (OR 2.90 [95% CI 2.08, 4.04]), LAVI (OR 1.62 [95% CI 1.13, 2.33]), TR velocity (OR 2.31 [95% CI 1.49, 3.57]), and LVMI (OR 1.70 [95% CI 1.31, 2.20]), while patients with severely decreased kidney function had higher odds for abnormal E/e' (OR 2.95 [95% CI 1.68, 5.17]) and LVMI > 95 g/m2 in women or >115 g/m2 in men (OR 2.07 [95% CI 1.27, 3.38]). The linear regression showed a significant inverse association between eGFR and echocardiography parameters, meaning that with worse kidney function, the parameters for LVDD worsened as well. Conclusions: Abnormal echocardiography parameters of LVDD were present even in patients with mildly decreased kidney function. As the kidney function worsened, there was a gradual increase in the risk of abnormal parameters of LVDD.