Derived Subendocardial Viability Ratio and Cardiovascular Events in Patients with Chronic Kidney Disease

Cardiorenal Med. 2019;9(1):41-50. doi: 10.1159/000493512. Epub 2018 Nov 8.

Abstract

Background: Chronic kidney disease (CKD) is a well-known mortality risk factor. The subendocardial viability ratio (SEVR) is one of the pulse wave analysis parameters that constitutes a non-invasive measure of coronary perfusion. We aimed to assess the prognostic value of the SEVR for cardiovascular outcome in non-dialysis CKD patients.

Methods: A total of 98 CKD patients (mean age 60 years) were prospectively followed up from the date of the SEVR measurement until their death or the start of dialysis/transplantation, maximally up to 7.1 years (mean 5 years). According to the manufacturer's instructions regarding normal SEVR values, the patients were divided into a low SEVR group (SEVR ≤130%, n = 26) and a normal SEVR group (SEVR > 130%, n = 72).

Results: During the follow-up period, 13 patients (13.3%) suffered fatal and 23 patients (23.5%) suffered combined (non-fatal and fatal) cardiovascular events. In the patients who died of cardiovascular causes, the SEVR values were statistically significantly lower (130 vs. 154%; p = 0.017) than in those who survived. A Kaplan-Meier survival analysis showed that the cardiovascular survival rate in the low SEVR group of patients was statistically significantly lower (log-rank test: p < 0.001). Using an unadjusted Cox regression analysis, the patients in the low SEVR group had a 5.6-fold higher risk (95% CI: 1.8-17.3; p = 0.002) of fatal cardiovascular events and a 2.7-fold higher risk (95% CI: 1.1-6.3; p = 0.024) of combined fatal and non-fatal cardiovascular events. In the adjusted Cox regression model, the patients in the low SEVR group had a 16-fold higher risk (95% CI: 1.2-9.7; p = 0.004) of fatal cardiovascular events and a 7-fold higher risk (95% CI: 1-9.7; p = 0.009) of combined fatal and non-fatal cardiovascular events.

Conclusions: An SEVR < 130% predicts fatal and non-fatal cardiovascular events in non-dialysis CKD patients.

Keywords: Applanation tonometry; Cardiovascular mortality; Chronic kidney disease; Subendocardial viability ratio.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cardiovascular Diseases / epidemiology*
  • Cardiovascular Diseases / etiology
  • Cardiovascular Diseases / physiopathology
  • Coronary Circulation / physiology*
  • Endocardium
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Prognosis
  • Pulse Wave Analysis / methods*
  • Renal Insufficiency, Chronic / complications*
  • Retrospective Studies
  • Risk Assessment / methods*
  • Risk Factors
  • Slovenia / epidemiology
  • Survival Rate / trends
  • Time Factors
  • Young Adult