Tissue Doppler-derived E/e' ratio as a parameter for assessing diastolic heart failure and as a predictor of mortality in patients with chronic kidney disease

Korean J Intern Med. 2013 Jan;28(1):35-44. doi: 10.3904/kjim.2013.28.1.35. Epub 2012 Dec 28.


Background/aims: Diastolic dysfunction occurs frequently in patients with chronic kidney disease (CKD) and is associated with heart failure (HF) or mortality. We investigated whether the ratio of early diastolic mitral inflow velocity to early diastolic mitral annulus velocity (E/e' ratio), estimated using tissue Doppler imaging, has prognostic value for cardiovascular morbidity and all-cause mortality in patients with CKD.

Methods: For 186 patients with CKD of stages III to V, we obtained echocardiograms with tissue Doppler imaging. A 5-year follow-up of 136 patients was performed based on hospital records and telephone interviews. The enrolled patients (79 males and 57 females) were categorized into the following CKD subgroups: stage III (n = 25); stage IV (n = 22); and stage V (n = 89).

Results: The average follow-up period was 30.45 months and the mean age of the patients was 61.13 years. The mortality rate after 5 years was 60.0%. The causes of death were: sepsis, 21.9%; HF, 16.2%; and sudden death, 15.2%. Age (p = 0.000), increased C-reactive protein level (p = 0.018), and increased E/e' ratio (p = 0.048) were found to correlate with mortality. Age (p = 0.000), decreased ejection fraction (p = 0.003), and increased E/e' ratio (p = 0.045) correlated with cardiovascular event.

Conclusions: The E/e' ratio can predict mortality and cardiovascular events in patients with CKD who have diastolic dysfunction.

Keywords: Chronic kidney disease; Diastolic heart failure; Echocardiography, Doppler; Mortality.

MeSH terms

  • Aged
  • Chi-Square Distribution
  • Echocardiography, Doppler*
  • Female
  • Glomerular Filtration Rate
  • Heart Failure, Diastolic / diagnostic imaging*
  • Heart Failure, Diastolic / mortality*
  • Heart Failure, Diastolic / physiopathology
  • Humans
  • Incidence
  • Kaplan-Meier Estimate
  • Kidney / physiopathology
  • Linear Models
  • Male
  • Middle Aged
  • Mitral Valve / diagnostic imaging
  • Mitral Valve / physiopathology
  • Predictive Value of Tests
  • Prognosis
  • Proportional Hazards Models
  • ROC Curve
  • Renal Insufficiency, Chronic / diagnosis
  • Renal Insufficiency, Chronic / mortality*
  • Renal Insufficiency, Chronic / physiopathology
  • Republic of Korea / epidemiology
  • Risk Assessment
  • Risk Factors
  • Stroke Volume
  • Time Factors
  • Ventricular Function, Left