Patterns of diastolic dysfunction and correlation with lung ultrasound B-lines among patients with end-stage renal disease

Introduction: Cardiovascular disease is the leading ca-use of death among patients with end-stage renal disea-se (ESRD). The degree of diastolic dysfunction (DD) as assessed by the E/e’ ratio correlates with worsening eGFR and the presence of diastolic dysfunction is an independent predictor of mortality for these patients.

Objective: To evaluate the patterns of DD in patients with end-stage renal disease not on renal replacement therapy (RRT) and investigate the correlation with lung ultrasound B-lines as an indicator of the hydration sta-tus.

Methods: Population: CKD patients with eGFR <15 ml/min/1.73m2 referred for echocardiography. Accor-ding to the ESC recommendations for DD assessment, the following parameters derived from conventional 2D echocardiography, tissue and conventional doppler imaging were used: average E/e’, septal and lateral e’ ve-locities, tricuspid regurgitation (TR) velocity, left atrial volume index (LAVi), E/A, E wave velocity, EF. Lung B-lines were assessed at the same time by scanning 28 intercostal spaces (IS) on the antero-lateral chest, 2nd-5th IS along with the midaxillary, anterior axillary, midclavicular and parasternal lines. In each IS, the B-li-nes were counted from 0=black lung to 10=white lung. Results: 60 patients (41 males) with an eGFR <15ml/ min/1.73m2 (CKD-EPI) were included (mean eGFR=8.3ml/min/1.73m2). The mean age was 61 (ran-ge 19-83) years old and 28.9% were diabetic. The num-ber of B-lines varied between 0 and 80, with a median of 21. Of the 60 patients enrolled, 19 patients (31.6%) had an EF of <50%. All of them had at least grade I and an increased LAVi. 41 patients (68.3%) had a preserved EF (pEF) and among these, 33 had dias-tolic dysfunction (80.4%). Overall, 52 of the 60 patients enrolled (86.6%) had DD (54.5% grade I, 42.4% grade II, 3% grade III). Mean E/e’, lateral and septal e’, LAVi, TR velocity and the grade of DD were inde-pendently correlated with the number of B-lines – as assessed by lung ultrasound (p=0.03, r=0.34; p=0.005, r=0.43; p=0.01, r=0.40; p=0.04, r=0.32; p=0.04; r=0.32 and p=0.02; r=0.37 respectively). Additionally, the number of B-lines correlated with eGFR (p=0.0008; r=0.51), hemoglobin (Hb) levels (p=0.03; r=0.33) and EF (p=0.0002; r=0.56). In multiple regression analysis of a model consisting of E/e’, eGFR, Hb and B-lines, the number of B-lines counted for 18% of the variance of E/e’ (R2=.118, p=0.03, F=4.833).

Conclusions: Our study confirms that DD is extre-mely common among patients with ESRD even in the presence of a pEF. Additionally, we proved for the first time, the independent correlation between the number of B-lines as assessed by lung ultrasound and the grade of DD in ESRD patients not yet on RRT. As it correlates with worse prognosis and mortality, further studies are needed to determine whether improving DD in pati-ents with ESRD translates into better outcomes.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)