Increasing dyssynchrony during 3 1 -Dimensional dobutamine stress echocardiography correlated with the 2-Year worsening echocardiography findings in continuous ambulatory peritoneal dialysis patients

Background: Left ventricular (LV) dyssynchrony is associated with increased all-cause mortality in patients with end-stage renal disease (ESRD), but similar data are not available fo patients undergoing continuous ambulatory peritoneal dialysis (CAPD). The objective was to determine whether dynamic dyssynchrony during stress tests plays a prognostic role with regard to unfavorable echocardiography outcomes in CAPD patients. Methods: We enrolled 55 continuous ambulatory peritoneal dialysis (CAPD) patients and 13 control group subjects, who did not have cardiovascular disease. A standard 3-dimensional (3D) dobutamine stress echocardiography (DSE) protocol was followed. LV systolic dyssynchrony indexes (SDI) and quantified mitral regurgitation (MR) of vena contracta area were calculated by real time 3D echocardiography. CAPD patients underwent repeat resting echocardiography at 2 years. Results LV ejection fraction was normal in the CAPD (67.1 ± 8.5%) and control (68.9 ± 3.4%) groups. There was also no significant difference in baseline SDI between the CAP (1.55 ± 1.10) and control (1.21 ± 0.52) groups, while SDI of peak dose dopamine wa significantly higher in the CAPD group (P = 0.012). The CAPD group showe significantly greater end diastolic volume (EDV), end systolic volume (ESV), LV mass indexes, and wall stress than those measured in normal subjects. After 2 years subgroup with higher peak-stage SDIs had significantly increased LV mass index, LV volume, left atrium, right ventricular dimensions, MR severity, and LV sphericity as compared with lower peak-stage SDIs subgroup in CAPD patients. Conclusion Dynamic LV dyssynchrony develops in CAPD patients during DSE, and correlates with the 2-year's unfavorable echocardiography outcomes. It may serve as a novel index of increased risk of worsening LV echocardiographic outcome at an early stage in CAPD patients regardless of preserved normal ejection fraction.