Left Ventricular Diastolic Dysfunction in the Early Stage of Chronic Kidney Disease

  • Takenori Otsuka, Toho University Ohashi Medical Center Cardiovascular Medicine, Japan
  • Makoto Suzuki, Toho University Ohashi Medical Center Cardiovascular Medicine, Japan
  • Hisao Yoshikawa, Toho University Ohashi Medical Center Cardiovascular Medicine, Japan
  • Tsukasa Osaki, Toho University Ohashi Medical Center Clinical Phisiology, Japan
  • Takako Tsuchida, Toho University Ohashi Medical Center Clinical Phisiology, Japan
  • Kaoru Sugi, Toho University Ohashi Medical Center Cardiovascular Medicine, Japan

    • Background: Disadvantageous effect of kidney dysfunction on left ventricular (LV) diastolic function is still unknown.
    Methods: The relationship of kidney dysfunction with LV diastolic function was examined in 40 healthy subjects and 202 patients (40 to 89 years old) with chronic kidney disease (CKD) using echocardiography and tissue Doppler imaging. The subjects were divided into 5 groups based on estimated glomerular filtration rates (GFR:ml/min/BSA): 1 (>90:normal subjects), 2 (60-89), 3 (30-59), 4 (15-29), and 5 (<15).
    Results: LV systolic function did not differ significantly among all groups. Mitral E velocity in groups 1-4 was lower than in group 5 (p<0.01-0.02) and mitral A velocity in groups 2-5 was higher than in group 1 (p<0.01-0.04). The ratio of the mitral E to A velocities (E/A) in group 1 was higher than in groups 2-5 (p<0.02-0.05). Early diastole velocity of the mitral annulus (Ea) in tissue Doppler imaging in group 1 (9.1±2.5) was also higher than in groups 2 (7.9±1.7), 3 (7.9±1.6), 4 (7.5±2.1) and 5 (7.6±2.0) (p<0.01-0.04). Severity of kidney dysfunction increased significantly with an increase in E/Ea (p<0.02). A, E/A and Ea differed between groups 1 (healthy controls) and 2 (early-stage CKD).
    Conclusions: These data suggest that LV diastolic dysfunction occurs at an early stage of chronic kidney dysfunction. Doppler indices combined with conventional and tissue Doppler imaging can detect subtle changes of diastolic function due to kidney dysfunction, and the LV filling pressure may elevate in end-stage CKD.