Oncotarget

Research Papers:

Association of type 2 diabetes mellitus and ratio of transmitral E wave velocity to early diastole mitral velocity with cardiovascular events in chronic kidney disease

Po-Chih Chen, Jiun-Chi Huang _, Szu-Chia Chen, Pei-Yu Wu, Jia-Jung Lee, Yi-Wen Chiu, Jer-Ming Chang, Hung-Chun Chen and Yeou-Lih Huang

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Oncotarget. 2017; 8:94407-94416. https://doi.org/10.18632/oncotarget.21768

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Abstract

Po-Chih Chen1,2, Jiun-Chi Huang3,4,5,6,*, Szu-Chia Chen3,4,5,6, Pei-Yu Wu4,5, Jia-Jung Lee4,6, Yi-Wen Chiu4,7, Jer-Ming Chang4,6,8, Hung-Chun Chen4,7 and Yeou-Lih Huang1,2,9,*

1Department of Medical Laboratory Science and Biotechnology, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan

2Department of Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

3Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

4Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

5Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

6Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

7Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

8Department of Internal Medicine, Kaohsiung Municipal Cijin Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

9Department of Chemistry, National Sun Yat-sen University, Kaohsiung, Taiwan

*These authors have contributed equally to this work

Correspondence to:

Jiun-Chi Huang, email: karajan77@gmail.com

Yeou-Lih Huang, email: yelihu@kmu.edu.tw

Keywords: diabetes mellitus, transmitral E wave velocity, early diastole mitral velocity, chronic kidney disease, cardiovascular event

Received: June 16, 2017    Accepted: September 21, 2017    Published: October 10, 2017

ABSTRACT

The association between DM and left ventricular diastolic dysfunction, assessed using the ratio of peak early transmitral filling wave velocity (E) to early diastolic velocity of mitral annulus (Ea), with cardiovascular (CV) outcomes in patients with chronic kidney disease (CKD) remains uncertain. This study included 356 CKD stage 3–5 patients underwent echocardiography. All patients were classified into four groups based on the presence of DM and E/Ea ≤ or > 9. CV events included CV death, hospitalization for heart failure, unstable angina or nonfatal myocardial infarction, sustained ventricular arrhythmia, transient ischemic attack, and stroke. There were 58 CV events during the mean observation period of 25.0 months. A combination of the presence of DM and E/Ea > 9 (vs. a combination of non-DM and E/Ea ≤ 9) was associated with CV events in unadjusted model (hazard ratio [HR], 6.990; 95% confidence interval [CI], 2.753–17.744; p < 0.001), and in a multivariate adjusted model (HR, 3.037; 95% CI, 2.088–7.177; p = 0.025). In the patients without DM, the E/Ea ratio (p = 0.033) improved the prediction of CV events, compared to the E/Ea ratio (p = 0.018), left atrial diameter (p = 0.016) and left ventricular mass index (p = 0.001) in the patients with DM. The combination of DM and left ventricular diastolic dysfunction was associated with CV events in patients with CKD stage 3–5. Assessments of DM status and E/Ea ratio may facilitate identifying high-risk patient population of unfavorable CV outcomes.


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