Treadmill exercise-induced E/e’ elevation as a predictor of cardiovascular event in end-stage renal disease on peritoneal dialysis

Abstract

Background/Aims: Diastolic dysfunction is associated with cardiovascular (CV) events in end-stage renal disease (ESRD) on continuous ambulatory peritoneal dialysis (CAPD). However, conventional measurement of LA volume and E/e’ using Doppler echocardiography has been limited to predict CV events in patients with ESRD on CAPD. Methods: From September 2007 to September 2008, 30 consecutive patients with exertional dyspnea in ESRD on CAPD and normal systolic function was prospectively enrolled and underwent laboratory testing, coronary angiography, and treadmill exercise stress echocardiography (TESE). We divided the patients according to the presence of exercise-induced change of E/e’ tissue Doppler and investigated whether this factor predicted CV events in ESRD on CAPD. Results: Mean CAPD duration of all patients (70% male; mean age, 49 years) was 12 months. Patients with exercise-induced elevated E/e’ (n = 12, 40%) and non-elevated E/e’ (n = 18, 60%) demonstrated similar baseline characteristics. Exercise-induced elevated E/e’ was predictable (cut-off value 14%, sensitivity 63%, and specificity 95%), with a hazard ratio of 1.13 (confidence interval, 1.03 to 1.24; p = 0.005), and significantly associated with CV events compared to the non-elevated E/e’ group (log-rank, p = 0.007). Conclusions: Exercise-induced elevated E/e’ determined using TESE might be feasible to predict CV events in patients with ESRD on CAPD.