The value of cardiopulmonary exercise testing and stress echocardiography in the prediction of all-cause mortality in adults with end stage renal disease
O'Driscoll, J., Edwards, J., Greenhough, E., Smith, E., May, M., Gupta, S., Marciniak, A and Sharma, R. 2023. The value of cardiopulmonary exercise testing and stress echocardiography in the prediction of all-cause mortality in adults with end stage renal disease. European Journal of Sport Science.
|Authors||O'Driscoll, J., Edwards, J., Greenhough, E., Smith, E., May, M., Gupta, S., Marciniak, A and Sharma, R.|
We aimed to assess the prognostic utility of different parameters routinely assessed from cardiopulmonary exercise testing (CPET) and exercise echocardiography in adults with end-stage renal disease (ESRD). Forty-two ESRD (37 male) individuals (age: 58±13 years, height: 169.30±8.30 cm, weight: 81±15 kg, body surface area: 1.92±0.20m2) underwent a maximal/symptom limited CPET, with a full cross-sectional echocardiogram performed at baseline and peak exercise. All participants were prospectively followed over a 10-year period, with all-cause mortality as the primary endpoint. After the follow-up period, a total of 19 participants (45%) died. Left atrial size (4.70±0.70 vs. 3.65±0.50 cm, P<0.001) and anteroseptal wall thickness (1.28±0.40 vs. 1.06±0.02 cm, P=0.002) were significantly greater in those that died, while peak heart rate was significantly lower (108±12 vs. 128±14 bpm, P<0.001). The prevalence of myocardial ischaemia (13 vs. 8 participants, P=0.03) was significantly greater, while peak VO2 (9.80±2.10 vs. 15.90±4.30 ml·kg-1·min-1, P<0.001) was significantly lower in those that died. Following multivariate cox regression, myocardial ischaemia (Hazard Ratio 3.08; 95% Confidence Interval 1.09 – 8.70; P=0.03) and peak VO2 (HR 0.73; 95% CI 0.64 – 0.84; P<0.001) were significant independent predictors of 10-year all-cause mortality. This is the first study to establish peak VO2 as powerful marker of all-cause mortality when assessed with clinical, resting and stress echocardiography parameters in people with ESRD over a 10-year follow up period. This observation indicates that, in clinical practice, CPET and exercise echocardiography may serve as valuable tools for the risk stratification of individuals with ESRD.
|Keywords||End-stage renal disease; Chronic kidney disease; Stress echocardiography; Cardiopulmonary exercise testing; Mortality|
|Journal||European Journal of Sport Science|
|Publisher||Taylor & Francis|
|Online||15 Mar 2023|
|Publication process dates|
|Accepted||13 Feb 2023|
|Deposited||22 Feb 2023|
|Accepted author manuscript|
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