Renal Failure

ISSN: 0886-022X (Print) 1525-6049 (Online) Journal homepage: http://www.tandfonline.com/loi/irnf20

Significant Correlation between Left Ventricular

Systolic and Diastolic Dysfunction and Decreased
Glomerular Filtration Rate

Ming-Chia Hsieh, Ho-Ming Su, Shu-Yi Wang, Dong-Hwa Tsai, Shi-Dou Lin, Szu-
Chia Chen & Hung-Chun Chen

To cite this article: Ming-Chia Hsieh, Ho-Ming Su, Shu-Yi Wang, Dong-Hwa Tsai, Shi-Dou Lin,
Szu-Chia Chen & Hung-Chun Chen (2011) Significant Correlation between Left Ventricular Systolic
and Diastolic Dysfunction and Decreased Glomerular Filtration Rate, Renal Failure, 33:10, 977-982,
DOI: 10.3109/0886022X.2011.618792

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Renal Failure, 33(10): 977–982, (2011)
Copyright © Informa Healthcare USA, Inc.
ISSN 0886-022X print/1525-6049 online
DOI: 10.3109/0886022X.2011.618792

CLINICAL STUDY

Significant Correlation between Left Ventricular Systolic and Diastolic

Dysfunction and Decreased Glomerular Filtration Rate

Ming-Chia Hsieh1 , Ho-Ming Su2,3,4 , Shu-Yi Wang1 , Dong-Hwa Tsai1 , Shi-Dou Lin1 ,
Szu-Chia Chen3,5 and Hung-Chun Chen5,6
1 Divisionof Endocrinology and Metabolism, Department of Medical, Changhua Christian Hospital, Changhua, Taiwan;
2 Divisionof Cardiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan;
3 Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung,

Taiwan; 4 Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; 5 Division of
Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University,
Kaohsiung, Taiwan; 6 Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

Abstract
Cardiac dysfunction portends a poor prognosis in renal failure and vice versa. Functional abnormalities of heart in
patients with renal insufficiency were frequently noted. The aim of this study is to assess the relationship between
left ventricular systolic and diastolic function and renal function in patients with various degrees of renal function.
This cross-sectional study included 167 patients from our Outpatient Department of Internal Medicine. Left ventricular
systolic and diastolic functions were assessed by echocardiography. Clinical and echocardiographic parameters were
compared and analyzed. The prevalence of left ventricular ejection fraction (LVEF) <50% was 31.7% and the average
value of the ratio of peak early transmitral filling wave velocity (E) to early diastolic velocity of lateral mitral annulus
(Ea) was 11.4 ± 6.2. After the multivariate analysis, low systolic blood pressure, rapid heart rate, low albumin, and low
estimated glomerular filtration rate (eGFR) (odds ratio = 0.957; 95% confidence interval = 0.929–0.986; p = 0.004)
levels were associated with LVEF < 50%. Besides, old age, low albumin, low eGFR (β = −0.172; p = 0.043), and high
uric acid levels were associated with high E/Ea. Our findings show a significant correlation between LVEF < 50% and
high E/Ea and decreased eGFR.

Keywords: left ventricular ejection fraction, the ratio of peak early transmitral filling wave velocity (E) to early diastolic
velocity of lateral mitral annulus (Ea), estimated glomerular filtration rate

INTRODUCTION Echocardiographic measures of left ventricular func-

tion and structure have been reported to predict adverse
Heart failure is associated with declining renal
cardiovascular outcomes in a variety of population.4,5
function.1 A general definition of cardiorenal syndrome
Therefore, identifying the factors contributing to
is disorders of the heart and kidneys whereby acute or
impaired left ventricular function is important. Func-
chronic dysfunction in one organ may induce acute or
tional abnormalities of heart in patients with renal
chronic dysfunction of the other.2 A failing heart can
insufficiency were frequently noted.6,7 The aim of this
promote renal function progression through a variety
study is to assess the relationship between left ventricu-
of pathophysiological mechanisms, including hemody-
lar systolic and diastolic function and renal function in
namic factors, systemic neurohormonal factors, drug
patients with various degrees of renal function and see
treatment, and anemia.2,3

Address correspondence to Szu-Chia Chen, Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung
Medical University, 482, Shan-Ming Road, Hsiao-Kang District, 812 Kaohsiung, Taiwan. Tel.: 886-7-8036783; Fax: 886-7-8063346;
E-mail: 0920497@kmhk.org.tw
Received 2 May 2011; Accepted 13 August 2011

977
978 M.-C. Hsieh et al.
if renal function impairment is a risk factor of impaired
left ventricular function.
SUBJECTS AND METHODS
Study Patients and Design
Study subjects were selected from the patients
arranged for echocardiographic examination at Kaohsi-
ung Municipal Hsiao-Kang Hospital. Patients with sig-
nificant aortic or mitral valve disease, atrial fibrillation,
hemodialysis, and inadequate image visualization were
excluded. Total 167 patients (mean age: 57.5 ± 13.7
years, 95 males/72 females) were enrolled from January
2007 to September 2007. The protocol was approved by
our institutional review board and all enrolled patients
gave written, informed consent.
Evaluation of Cardiac Structure and Function
The echocardiographic examination was performed by
an experienced sonographer using transthoracic echocar-
diography (Vivid 7; General Electric Medical Systems,
Horten, Norway), with the participant respiring quietly
in the left decubitus position. Two-dimensional and two-
dimensionally guided M-mode images were recorded
from the standardized views. The Doppler sample vol-
ume was placed at the tips of the mitral leaflets to get the
left ventricular inflow waveforms from the apical four-
chamber view. All sample volumes were positioned with
ultrasonic beam alignment to flow. Tissue Doppler imag-
ing was obtained with the sample volume placed at the
lateral corner of the mitral annulus from the apical four-
chamber view. The wall filter settings were adjusted to
exclude high-frequency signals and the gain was mini-
mized. The echocardiographic measurements included
aortic root diameter, left ventricular end-diastolic vol-
ume, left ventricular end-systolic volume, left ventricular
ejection fraction (LVEF), peak early transmitral filling
wave velocity (E), peak late transmitral filling wave veloc-
ity (A), E-wave deceleration time, early diastolic velocity
of lateral mitral annulus (Ea), and late diastolic velocity
of lateral mitral annulus (Aa). Left ventricular mass was
calculated using Devereux-modified method.8 Left ven-
tricular mass index (LVMI) was calculated by dividing
left ventricular mass by body surface area. Left ventric-
ular hypertrophy (LVH) was considered to be present
when LVMI exceeded 134 and 110 g/m2 for men and
women, respectively.9 LVEF was measured by the mod-
ified Simpson’s method. The raw ultrasonic data were
recorded and analyzed offline by a cardiologist, blinded
to the other data, using EchoPAC software (GE Medical
Systems, Horten, Norway). The echocardiographic data
were obtained from three consecutive beats and then
the data were averaged to give the mean value for later
analysis.
Collection of Demographic, Medical, and Laboratory
Data
Demographic and medical data including age, gender,
smoking history (ever vs. never), and comorbid
conditions were obtained from medical records or inter-
views with patients. Study subjects were defined as
having diabetes mellitus (DM) if the fasting blood
glucose level was greater than 126 mg/dL or hypo-
glycemic agents were used to control blood glucose
levels. Similarly, study patients were considered as hav-
ing hypertension if the systolic blood pressure was ≥140
mmHg or diastolic blood pressure was ≥90 mmHg
or antihypertensive drugs were prescribed. Coronary
artery disease was defined as a history of typical angina
with positive stress test, angiographically documented
coronary artery disease, old myocardial infarction, or
having undergone coronary artery bypass surgery or
angioplasty. Cerebrovascular disease was defined as
a history of cerebrovascular accident including cere-
bral bleeding and infarction. The body mass index
was calculated as the ratio of weight in kilograms
divided by square of height in meters. Laboratory data
were measured from fasting blood samples using an
autoanalyzer (COBAS Integra 400, Roche Diagnos-
tics GmbH, D-68298, Mannheim, Germany). Serum
creatinine was measured by the compensated Jaffé
(kinetic alkaline picrate) method in a Roche/Integra 400
Analyzer (Roche Diagnostics, Mannheim, Germany)
using a calibrator traceable to isotope-dilution mass
spectrometry.10 The value of estimated glomerular fil-
tration rate (eGFR) was calculated using Modified
Chinese Modification of Diet in Renal Disease equa-
tion due to racial reason.11 Proteinuria was exam-
ined by dipsticks (Hema-Combistix, Bayer Diagnos-
tics, New York, USA). A test result of 1+ or more
was defined as positive. Blood and urine samples
were obtained within 1 month of enrollment. In addi-
tion, information regarding patient medications includ-
ing angiotensin-converting enzyme inhibitors (ACEI),
angiotensin II receptor blockers (ARB), non-ACEI
and/or ARB antihypertensive drugs during the study
period was obtained from medical records.
Statistical Analysis
Statistical analysis was performed using SPSS version
12.0 (SPSS Inc., Chicago, IL, USA) for Windows.
Data are expressed as percentages or mean ± standard
deviation or median (25th–75th percentile) for triglyc-
eride. The differences between groups were checked by
chi-square test for categorical variables or by indepen-
dent t-test for continuous variables. Logistic and linear
regression analysis were used to identify the factors
associated with LVEF < 50% and E/Ea, respectively.
Significant variables in univariate analysis were selected
for multivariate analysis. A difference was considered
significant if the p-value was less than 0.05.
RESULTS
The comparison of baseline characteristics between
patients with eGFR < 60 mL/min/1.73 m2 and eGFR ≥
60 mL/min/1.73 m2 were shown in Table 1. The mean
Renal Failure
 LV Function and eGFR 979

Table 1. Comparison of baseline characteristics between patients with eGFR < 60 mL/min/1.73 m2 and eGFR ≥
60 mL/min/1.73 m2 .
eGFR < 60 (n = 43) eGFR ≥ 60 (n = 124) p-Value All patients (n = 167)
Age (year) 61.4 ± 14.8 56.1 ± 13.2 0.030 57.5 ± 13.7
Male gender (%) 60.5 55.6 0.582 56.9
Smoking history (%) 37.8 34.7 0.732 35.5
Diabetes mellitus (%) 44.2 23.4 0.009 28.7
Hypertension (%) 69.8 62.1 0.366 64.1
Coronary artery disease (%) 27.9 18.5 0.194 21.0
Cerebrovascular disease (%) 4.7 4.0 1.000 4.2
Systolic blood pressure (mmHg) 140.0 ± 22.9 135.6 ± 20.4 0.249 136.7 ± 21.1
Diastolic blood pressure (mmHg) 80.5 ± 13.4 80.0 ± 11.2 0.805 80.1 ± 11.8
Pulse pressure (mmHg) 59.5 ± 15.6 55.7 ± 15.1 0.161 56.6 ± 15.3
Heart rate (beats/min) 73.5 ± 14.2 70.5 ± 13.7 0.229 71.3 ± 13.9
Body mass index (kg/m2 ) 25.4 ± 3.5 25.7 ± 4.2 0.707 25.6 ± 4.0
Laboratory parameters
Albumin (g/dL) 3.91 ± 0.50 4.07 ± 0.42 0.071 4.03 ± 0.45
Fasting glucose (mg/dL) 122.9 ± 41.3 118.3 ± 49.7 0.597 119.5 ± 47.6
Triglyceride (mg/dL) 145.0 (81.5–188.3) 135.5 (95.0–199.5) 0.597 139.0 (92.0–198.0)
Cholesterol (mg/dL) 189.1 ± 52.3 210.3 ± 90.3 0.154 204.8 ± 82.5
Hematocrit (%) 39.0 ± 6.6 42.8 ± 4.4 0.001 41.8 ± 5.3
eGFR (mL/min/1.73 m2 ) 44.2 ± 14.7 88.4 ± 14.6 <0.001 57.0 ± 17.1
Uric acid (mg/dL) 8.3 ± 2.4 6.4 ± 1.9 <0.001 6.9 ± 2.2
Proteinuria (%) 47.5 16.2 <0.001 24.2
Medications
ACEI and/or ARB use (%) 72.1 49.2 0.009 55.1
Non-ACEI/ARB 79.1 66.9 0.134 70.1
antihypertensive drug use (%)
Echocardiographic data
LVEDV (mL) 141.9 ± 58.2 115.1 ± 51.9 0.005 122.0 ± 54.7
LVESV (mL) 85.5 ± 58.2 55.0 ± 49.1 0.001 62.8 ± 53.1
LVMI (g/m2 ) 128.2 ± 37.7 104.5 ± 30.9 <0.001 110.6 ± 34.3
LVH (%) 32.6 21.8 0.157 24.6
LVEF (%) 45.8 ± 20.4 58.1 ± 16.9 0.001 54.9 ± 18.6
LVEF < 50% (%) 60.5 21.8 <0.001 31.7
E (cm/s) 86.0 ± 29.6 81.0 ± 21.2 0.240 82.3 ± 23.7
A (cm/s) 81.9 ± 19.5 76.6 ± 20.7 0.144 78.0 ± 20.5
E/A 1.15 ± 0.56 1.19 ± 0.67 0.693 1.18 ± 0.64
EDT (ms) 180.5 ± 57.9 186.6 ± 57.1 0.552 185.0 ± 57.2
Ea (cm/s) 6.4 ± 3.3 9.4 ± 3.2 <0.001 8.6 ± 3.5
Aa (cm/s) 8.1 ± 2.7 9.6 ± 3.0 0.005 9.2 ± 3.0
E/Ea 16.2 ± 7.7 9.7 ± 4.6 <0.001 11.4 ± 6.2
Notes: eGFR, estimated glomerular filtration rate; ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin II receptor
blocker; LVEDV, left ventricular end-diastolic volume; LVESV, left ventricular end-systolic volume; LVMI, left ventricular mass
index; LVH, left ventricular hypertrophy; LVEF, left ventricular ejection fraction; E, peak early transmitral filling wave velocity; A,
peak late transmitral filling wave velocity; EDT, E-wave deceleration time; Ea, early diastolic velocity of lateral mitral annulus; Aa,
late diastolic velocity of lateral mitral annulus.

age of all patients was 57.5 ± 13.7 years. The preva-
lence of LVEF < 50% was 31.7% and the average value
of E/Ea was 11.4 ± 6.2. Compared with patients with
eGFR ≥ 60 mL/min/1.73 m2 , patients with eGFR <
60 mL/min/1.73 m2 had an older age, higher prevalence
of a history of DM, lower hematocrit, higher uric acid,
higher prevalence of proteinuria, and higher percent-
age of receiving ACEI and/or ARB therapy. In addition,
patients with eGFR < 60 mL/min/1.73 m2 had a
higher left ventricular end-diastolic volume, higher left
ventricular end-systolic volume, higher LVMI, higher
prevalence of LVH, lower LVEF, higher prevalence of
LVEF < 50%, lower Ea, lower Aa, and higher E/Ea.
The comparison of baseline characteristics between
LVEF < 50% and LVEF ≥ 50% in study patients were
shown in Table 2. Compared with patients with LVEF ≥
50%, patients with LVEF < 50% were significantly asso-
ciated with male, higher prevalence of a history of smok-
ing, higher prevalence of DM, lower systolic blood pres-
sure, lower pulse pressure, more rapid heart rate, lower
albumin, higher fasting glucose, lower eGFR, higher
uric acid, higher prevalence of proteinuria, and higher
percentage of having received ACEI and/or ARB ther-
apy. After multiple forward logistic regression analysis
(Table 3), LVEF < 50% were significantly associated
with low systolic blood pressure, rapid heart rate, low

© 2011 Informa Healthcare USA, Inc.

980 M.-C. Hsieh et al.

Table 2. Comparison of baseline characteristics between patients with LVEF < 50% and LVEF ≥ 50%.
LVEF < 50% (n = 53) LVEF ≥ 50% (n = 114) p-Value
Age (year) 56.2 ± 15.9 58.1 ± 12.7 0.440
Male gender (%) 69.8 50.9 0.021
Smoking history (%) 54.5 27.9 0.002
Diabetes mellitus (%) 41.5 22.8 0.013
Hypertension (%) 56.6 67.5 0.170
Coronary artery disease (%) 28.3 17.4 0.111
Cerebrovascular disease (%) 3.8 4.4 1.000
Systolic blood pressure (mmHg) 129.0 ± 20.9 140.3 ± 20.3 0.001
Diastolic blood pressure (mmHg) 79.8 ± 13.3 80.3 ± 11.1 0.793
Pulse pressure (mmHg) 49.2 ± 14.8 60.1 ± 14.4 <0.001
Heart rate (beats/min) 81.0 ± 16.4 66.8 ± 9.7 <0.001
Body mass index (kg/m2 ) 26.2 ± 4.4 25.3 ± 3.9 0.197
Laboratory parameters
Albumin (g/dL) 3.75 ± 0.53 4.13 ± 0.37 <0.001
Fasting glucose (mg/dL) 132.1 ± 58.3 113.6 ± 40.5 0.044
Triglyceride (mg/dL) 149.5 (93.5–262.3) 132 (91.8–185.0) 0.084
Total cholesterol (mg/dL) 200.6 ± 76.0 206.8 ± 85.6 0.656
Hematocrit (%) 42.0 ± 5.6 41.8 ± 5.2 0.799
eGFR (mL/min/1.73 m2 ) 64.3 ± 23.3 75.3 ± 20.4 0.002
Uric acid (mg/dL) 7.9 ± 2.6 6.5 ± 1.8 0.001
Proteinuria (%) 41.7 16.5 0.001
Medications
ACEI and/or ARB use (%) 75.5 45.6 <0.001
Non-ACEI/ARB 73.6 68.4 0.498
antihypertensive drug use (%)
Note: eGFR, estimated glomerular filtration rate; ACEI, angiotensin-converting enzyme inhibitor; ARB,
angiotensin II receptor blocker.

Table 3. Multiple forward logistic regression analysis of factors DISCUSSION

associated with LVEF < 50%.
In the present study, we evaluated the association of
Variable Odds ratio (95% p-Value
confidence interval)
left ventricular function and renal function and found
that there was a significant correlation between LVEF
Systolic blood pressure 0.960 (0.929–0.992) 0.016 < 50% and high E/Ea and decreased eGFR. Other fac-
(per 1 mmHg)
Heart rate (per 1 1.098 (1.043–1.156) <0.001 tors such as low systolic blood pressure, rapid heart rate,
beats/min) and hypoalbuminemia were associated with LVEF <
Albumin (per 1 g/dL) 0.079 (0.017–0.372) 0.001 50% and old age, hypoalbuminemia, and hyperuricemia
eGFR (per 1 0.957 (0.929–0.986) 0.004 were associated with high E/Ea.
mL/min/1.73 m2 ) Because cardiac dysfunction portends a poor progno-
Notes: Values expressed as odds ratio (95% confidence interval). sis in renal failure and vice versa, there has been a recent
eGFR, estimated glomerular filtration rate; ACEI, angiotensin- surge of interest in identifying exact pathophysiologi-
converting enzyme inhibitor; ARB, angiotensin II receptor
cal connection between the failing heart and kidneys.
blocker. Covariates in the model included gender, a history of
smoking and diabetes mellitus, systolic blood pressure, pulse Ronco2 present a new classification of the cardiorenal
pressure, heart rate, albumin, fasting glucose, eGFR, uric acid, syndrome with five subtypes that reflect the primary and
proteinuria, and ACEI and/or ARB use (–2 Log likelihood: 78.5; secondary pathophysiology, the timeframe, and simul-
Nagelkerke R2 : 0.551). taneous cardiac and renal co-dysfunction secondary to
systemic disease. The mechanisms of the linkage of
renal insufficiency and cardiac dysfunction are multi-
albumin, and low eGFR (odds ratio = 0.957; 95% factors including chronic renal hypoperfusion, subclin-
confidence interval = 0.929–0.986; p = 0.004). ical inflammation, endothelial dysfunction, accelerated
Table 4 shows the determinants of the E/Ea in all atherosclerosis, increased renal vascular resistance, sys-
patients. In the univariate analysis, the E/Ea had a temic neurohormonal factors, pharmacotherapies, and
significantly positive correlation with age, heart rate, anemia.2 Structural and functional abnormalities of
uric acid, and ACEI and/or ARB therapy, and negative heart in patients with renal insufficiency were frequently
correlation with albumin and eGFR. After multiple for- noted because of pressure and volume overload.6,7 Our
ward linear regression analysis, high E/Ea was correlated study also revealed that impaired left ventricular systolic
independently with old age, low albumin, low eGFR and diastolic function were significantly associated with
(β = −0.172; p = 0.043) and high uric acid. decreased eGFR.

Renal Failure
 LV Function and eGFR 981

Table 4. Determinants of E/Ea in study patients.

Univariate Multivariate (forward)
Parameter Standardized Standardized
p-Value p-Value
coefficient β coefficient β
Age (year) 0.224 0.004 0.259 0.001
Male gender (%) 0.009 0.909 – –
Smoking history (%) 0.119 0.141 – –
Diabetes mellitus (%) 0.127 0.101 – –
Hypertension (%) 0.021 0.791 – –
Coronary artery disease (%) 0.066 0.406 – –
Cerebrovascular disease (%) 0.030 0.698 – –
Systolic blood pressure (mmHg) −0.065 0.406 – –
Diastolic blood pressure (mmHg) −0.046 0.556 – –
Pulse pressure (mmHg) −0.054 0.489 – –
Heart rate (beats/min) 0.229 0.003 – –
Body mass index (kg/m2 ) 0.001 0.987 – –
Laboratory parameters
Albumin (g/dL) −0.310 <0.001 −0.315 <0.001
Fasting glucose (mg/dL) 0.065 0.417 – –
Triglyceride (log mg/dL) 0.049 0.532 – –
Cholesterol (mg/dL) −0.097 0.221 – –
Hematocrit (%) −0.161 0.043 – –
eGFR (mL/min/1.73 m2 ) −0.359 <0.001 −0.172 0.043
Uric acid (mg/dL) 0.353 <0.001 0.207 0.015
Proteinuria (%) 0.119 0.139 – –
Medications
ACEI and/or ARB use (%) 0.224 0.004 – –
Non-ACEI and/or ARB 0.132 0.088 – –
antihypertensives use (%)
Notes: Adjusted R2 = 0.312. Values expressed as standardized coefficient β. eGFR, estimated
glomerular filtration rate; ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin II
receptor blocker.

This study also found that low serum albumin level
was significantly associated with impaired left ven-
tricular systolic and diastolic function. Malnutrition
may worsen patients’ outcome by aggravating existing
inflammation and heart failure.12 A low serum albumin
level has been regarded as a malnutrition status. Hypoal-
buminemia has been reported to be correlated with left
ventricular function.13,14 Trovato et al.14 investigated
the correlation between heart failure and nutritional sta-
tus in hemodialysis patients and found a low serum
albumin level was associated with decreased LVEF. Kur-
sat et al.13 also investigated the relationship between the
degree of malnutrition and echocardiographic parame-
ters in 72 hemodialysis patients. They found that the
malnutrition index, calculated using Subjective Global
Assessment, had a positive correlation with left ven-
tricular mass and index. They explained their findings
by inadequate volume control. Volume overload may
increase the diastolic wall stress and in turn cause LVH
and left ventricular diastolic abnormality.
Hyperuricemia is a well-known risk factor for car-
diovascular disease.15 Hyperuricemia is also a marker
of impaired oxidative metabolism, which may correlate
with left ventricular systolic and diastolic dysfunction
in patients with chronic heart failure.16–19 Heart fail-
ure is a state of chronic deterioration of oxidative
mechanisms due to enhanced oxidative stress and
upregulated oxidant-producing enzymes, in particular
xanthine oxidase. This impaired oxidative metabolism
may be implicated in the development of cardiac hyper-
trophy, myocardial fibrosis, left ventricular remodel-
ing, and contractility impairment.20 Cicoira et al.16
evaluated the impact of elevated uric acid levels on
cardiac function in 150 patients with dilated car-
diomyopathy. They found uric acid levels correlated
significantly with E, E/A ratio, E-wave deceleration
time, and restrictive mitral filling pattern, which were
markers of diastolic dysfunction.16 Our results consis-
tently demonstrated that elevated uric acid levels were
independently associated with left ventricular diastolic
dysfunction.
In conclusion, our results demonstrated there was
a significant correlation between LVEF < 50% and
high E/Ea and decreased eGFR. Other factors such as
hypoalbuminemia and hyperuricemia were also associ-
ated with left ventricular dysfunction.
Declaration of interest: The authors report no con-
flicts of interest. The authors alone are responsi-
ble for the content and writing of the paper. The
results presented in this paper have not been published
previously in whole or part, except in abstract format.

© 2011 Informa Healthcare USA, Inc.

982 M.-C. Hsieh et al.
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