Abstract 1858: Systolic Left Ventricular Dysfunction Is A Stronger Predictor Of Mortality Than Perfusion Pattern In End-Stage Renal Disease
Background More patients (pts) with end stage renal disease (ESRD) die each year awaiting renal transplant (RTx) than those who receive it. Many deaths are related to ischemic heart disease (IHD). There is a lack of data on the relative impact of systolic LV dysfunction on mortality.
Methods 2876 pts with ESRD were evaluated for Rtx from 2002–2004 were studied. We analyzed the subset that had myocardial perfusion imaging (MPI). Demographic and mortality data were collected prospectively and verified by searching the Social Security mortality database.
Results 1750 pts (61% of total) had stress MPI. Of those, 19.3% (338 pts) had abnormal perfusion (63% or 213 pts had ischemia ± scar and 37% or 88 pts had only scar). Of the gated SPECT studies (1598 pts or 91%), 15% (240 pts) had LV ejection fraction (LVEF) ≤40% and 50% had LVEF <55%. Abnormal perfusion was associated with increased mortality (HR 1.78, 1.4 – 2.27) regardless of the type of perfusion abnormality (ischemia vs. scar) (p=0.58). LVEF was associated with mortality in a graded fashion: ≤40% HR 2.7 (1.94 – 3.86), 41–50% HR 2.0 (1.42 – 2.82) and EF 51–60% HR 1.2 (.87 – 1.69). See figure⇓. Multivariable analysis showed that LV dysfunction (≤40% HR 2.3 p<.001, 41–50% HR 1.79 p=.002) was a stronger predictor of mortality than perfusion (HR 1.3 p=.06). Other independent predictors of mortality were diabetes (HR 1.75 p<.001), age >45 (HR 1.6 p=.003) and LVH by ECG (HR 1.5 p=.002).
Conclusion In ESRD, systolic LV dysfunction is a strong and independent predictor of mortality; stronger than the presence of perfusion abnormality and other traditional risk factors. Interventions aimed at improving LV dysfunction should be targeted to impact survival.