Ventricular function and all-cause mortality in chronic kidney disease patients with angiographic coronary artery disease

Background: Coronary artery disease (CAD) and chronic kidney disease (CKD) lead to high morbidity and mortality rates. Traditional and nontraditional risk factors, hypertension, fluid overloading and anemia can lead to myocardial ischemia, chamber hypertrophy and dilatation, and low left ventricular ejection fraction (LVEF) in CKD patients. The angiographic feature, ventriculographic LVEF and its relationship to all-cause mortality are unclear in patients with different stages of CKD who are not yet on dialysis. Methods: This retrospective study involved 980 CKD patients with suspected myocardial ischemia who underwent coronary angiography from 1995 to 2004. Demographic, clinical data and ventriculographic LVEF were assessed. Risk estimations for mortality were performed using Cox proportional hazard regression models. Results: Of the CKD patients, 445 (45.4%) had angiographic CAD. Their hemoglobin, body mass index (BMI) and LVEF values decreased with decrease in eGFR. Using Cox proportional hazard regression analysis, low LVEF was independently associated with CKD after adjustment for age, sex, diabetes, hypertension, BMI, hemoglobin and the presence of CAD. Significant independent prognostic factors for mortality included diabetes (hazard ratio [HR]= 2.946; 95% confidence interval [95% CI], 1.185-7.322), BMI (HR=0.864; 95% CI, 0.757-0.985), hemoglobin (HR=0.742; 95% CI, 0.594-0.928) and LVEF (HR=0.944; 95% CI, 0.918-0.970). Low LVEF was the only independent significant prognostic factor in CKD patients with angiographic CAD (HR=0.957; 95% CI, 0.918-0.996). Conclusion: LVEF reduction was independently associated with CKD. Low LVEF was an independent predictor of mortality in CKD patients regardless of the presence of angiographic CAD.