Prognostic Value of Right Ventricular Function Assessment by Echocardiography in End-Stage Renal Disease Patients on Maintenance Hemodialysis in Myanmar: A Prospective Observational Cohort Study
TL;DR
Despite overall mortality being lower than historical national averages, RV dysfunction was an independent predictor of adverse cardiovascular outcomes in this optimized hemodialysis cohort.
Abstract
Background Cardiovascular disease is the leading cause of mortality among End-Stage Renal Disease (ESRD) patients in Southeast Asia. While left ventricular function is routinely assessed, the prognostic significance of right ventricular (RV) dysfunction remains critically understudied in Myanmar. Objectives To determine the prevalence of RV dysfunction in maintenance hemodialysis patients and evaluate its independent association with a composite risk of one-year all-cause mortality and cardiovascular hospitalization. Methods This prospective observational cohort study enrolled 200 adult ESRD patients. To minimize volume loading artifacts, comprehensive post-dialysis transthoracic echocardiography was performed. RV function was assessed using Tricuspid Annular Plane Systolic Excursion (TAPSE), RV Fractional Area Change, and Tissue Doppler Systolic Velocity. The primary composite endpoint evaluated 12-month all-cause mortality and decompensated heart failure hospitalization. Results The cohort (mean age 53.1±12.4 years; 62% male) exhibited a 41.3% prevalence of RV dysfunction (TAPSE < 17 mm). Over a 12-month median follow-up, the primary endpoint occurred in 26.7% of patients. Non-survivors presented with significantly lower TAPSE (13.8±3.1 vs. 18.9±4.2 mm, p<0.001) and serum albumin. Kaplan-Meier analysis indicated significantly reduced event-free survival for patients with RV dysfunction (p<0.001). Following multivariable Cox regression adjustment for age, LVEF, dialysis vintage, and nutritional status, TAPSE < 17 mm remained a strong independent predictor of the composite outcome (HR: 2.38; 95% CI: 1.55-3.72; p<0.001). Conclusions Despite overall mortality being lower than historical national averages, RV dysfunction was an independent predictor of adverse cardiovascular outcomes in this optimized hemodialysis cohort.