Abstract 4042: Diabetes Mellitus and Systolic Dysfunction in End-Stage Renal Disease
Background Diabetes (DM) is the most common cause of end-stage renal disease (ESRD) in this country. It is also one of the strongest cardiovascular risk factors in the general population. However, there is a paucity of data on the relative impact of systolic LV dysfunction on mortality in this population.
Methods 2876 pts with ESRD were evaluated for Renal transplant (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, 59.8% (1047 pts) had DM. Of the gated SPECT studies (1598 pts or 91%), 15% or 150 pts were diabetics with LVEF ≤40% and 85% or 840 pts were diabetics with LVEF > 40%. Diabetes was associated with increased risk of mortality (HR 1.69, 1.33 − 2.16) regardless of the degree LVEF dysfunction. LVEF in diabetics was associated with increased risk of mortality in a graded fashion: ≤40% HR 3.1 (2.05 − 4.73), 41–50% HR 2.5 (1.64 − 3.71) and EF 51– 60% HR 1.3 (.87 − 1.97). Multivariable analysis showed that in diabetics, LV dysfunction (≤40% HR 2.2 p=.001, 41–50% HR 1.94 p=.002) was a strong predictor of mortality. In non-diabetics LV dysfunction was a predictor of mortality only with severe LV dysfunction (≤40% HR 2.2 p=.013).
See figure⇓: Conclusion In ESRD, systolic LV dysfunction is a strong and independent predictor of mortality. Diabetics with moderately reduced LVEF are at similar mortality risk to non-diabetics with severe LV dysfunction. Interventions aimed at improving LV dysfunction should be targeted to impact survival.