Correlation between right ventricular dysfunction and mortality risk in maintenance hemodialysis patients

Xu Kangshi; Jia Jing; Li Xuelian; Zhu Chengzhen; Xu Yuan; Jin Aiqing

doi:10.13498/j.cnki.chin.j.ecc.2025.04.08

Abstract：Objective To evaluate the association between right ventricular dysfunction(RVD)and with the risk of cardiovascular events and all-cause mortality in patients undergoing maintenance hemodialysis(MHD).Methods Between February 2019 and February 2023,137 patients with end-stage renal disease(ESRD)who had undergone MHD for more than one year were assessed for cardiac function and followed up.The study endpoints included cardiovascular events and all-cause mortality.RVD was defined by meeting at least two of the following criteria:(1)tricuspid annular systolic escursion(TAPSE)<17 mm;(2)tricuspid regurgitation velocity<10 cm/s;or(3)right ventricular area change fraction<35%.Spearman correlation analysis was performed to assess relationships between various cardiac parameters.The COX proportional hazards model and Kaplan-Meier survival analysis were used to evaluate the association between RVD and endpoint events.Results Of the 137 patients,56(40.88%)were classified into the RVD group.Compared with the non-RVD group,the RVD group exhibited significantly higher left ventricular end-diastolic diameter(LVEDD),left ventricular end-diastolic volume index(LVEDVI),left ventricular end-systolic volume index(LVESVI),right ventricular end diastolic volume index(RVEDVI),right ventricular end systolic volume index(RVESVI),and the ratio of mitral flow velocity to annular velocity(E/e')(P<0.05).Conversely,the left ventricular stroke volume index(LVSVI),right ventricular stroke volume index(RVSVI),left ventricular ejection fraction(LVEF),and RVEF were significantly lower in the RVD group(P<0.05).Spearman correlation analysis revealed that RVEDVI was significantly positively correlated with LVEDD(rs=0.516),LVESD(rs=0.341),RVEDD(rs=0.519),LVEDVI(rs=0.491),LVESVI(rs=0.273),LVSVI(rs=0.331),RVESVI(rs=0.345),RVSVI(rs=0.664)and E/e'(rs=0.411),while being significantly negatively correlated with LVEF(rs=-0.233)and RVEF(rs=-0.342),all P<0.05.RVEF showed a significant negative correlation with LVEDD(rs=-0.176),LVESD(rs=-0.436),RVEDD(rs=-0.294),LVEDVI(rs=-0.202),RVESVI(rs=-0.384)and E/e'(rs=-0.229),and a positive correlation with LVSVI(rs=0.336),LVEF(rs=0.507),and RVSVI(rs=0.379),all P<0.05.A weak negative correlation was found between LVEF and E/e'(rs=-0.184,P=0.038).During a median follow-up of 18 months(from 3-18 months),34 patients(24.82%)reached the study endpoint.The incidence of endpoint events was significantly higher in the RVD group compared to the non-RVD group(P<0.001),and the event-free survival time was significantly shorter in the RVD group(P<0.001).COX regression analysis identified RVD as an independent risk factor for the occurrence of endpoint events(P<0.05).Conclusion Accurate assessment of right ventricular function is critical for prognostication in MHD patients,as right ventricular parameters provide valuable prognostic information and may assist in risk stratification of this patient population.