Nephrology Dialysis Transplantation Letters and Replies 90 Mmhg). Mean (±sd) Systolic Blood Pressure Was 2. 168±28 and Diastolic Blood Pressure 101±14 Mmhg. Serum

than the average haemoglobin concentration of the health Does E/A ratio correctly estimate diastolic dysfunction population. In this connection the statement that ‘... an in patients with chronic renal failure? impaired LV filling is the diagnostic criteria that favours the diagnosis ‘‘pathologic’’ LV hypertrophy (decreased E/A ratio, Sir, i.e. the ratio of early to late diastolic filling) ...’ [1] is right, In the December 1999 issue of NDT, Klingbeil and Schmieder but the E/A ratio may not be an entirely adequate parameter [1] presented an editorial comment on left ventricular hyperin patients with CRF. trophy (LVH) in chronic renal failure (CRF). Diastolic We conclude that the E/A ratio does not reflect the real dysfunction due to LVH and some other factors is a common situation of diastolic function in patients with CRF and finding in these patients. We agree that ratio of early to late anaemia and that we may actually underestimate diastolic diastolic filling (E/A) is the most common parameter used dysfunction in this clinical situation. Other parameters such for estimation of diastolic function in clinical practice. as IVRT should not be ignored. However, patients with CRF commonly have anaemia and haemorheological abnormalities which can influence on diaDepartment of Internal Medicine A. M. Shutov stolic filling. Therefore, the question is whether the E/A ratio Ulyanovsk State University N. I. Kondratyeva is a correct parameter to use in this situation? Central City Hospital E. S. Kulikova We studied 32 non-diabetic pre-dialysis patients (13 M, Ulyanovsk 19 F, mean age 47.4±11.6 years) without clinical evidence Russian Federation of severe heart failure (III–IV class on NYHA). Twenty1. Klingbeil AU, Schmieder RE. Not all left ventricular hypertrophy eight (87.5%) patients had arterial hypertension ( 140 and is created equal. Nephrol Dial Transplant 1999; 14: 2803–2805 90 mmHg). Mean (±SD) systolic blood pressure was 2. Kunz K, Dimitrov Y, Muller S. Uraemic cardiomyopathy. 168±28 and diastolic blood pressure 101±14 mmHg. Serum Nephrol Dial Transplant 1998; 13 [Suppl. 4]: S39–S43 creatinine was 281±188 mmol/l and haemoglobin 12.2±1.9 3. Cohen-Solar A. Left ventricular diastolic dysfunction: patho(range 7.5–16.0) g/dl. The patients did not receive erythrophysiology, diagnosis and treatment. Nephrol Dial Transplant 1998; 13 [Suppl. 4]: S3–S5 poietin. Eighteen age and sex-matched health subjects were 4. Foley RN, Parfrey PS, Harnett JD et al. The impact of anemia studied (control group). Diastolic filling parameters were on cardiomyopathy, morbidity and mortality in end-stage renal measured with pulsed Doppler echocardiography with a disease. Am J Kidney Dis 1996; 28: 53–61 3.5 MHz transducer (Aloka SSD-2000). Measurements were 5. European best practice guidelines for the management of anaemia made in the standard apical four-chamber view with the in patients with chronic renal failure. Nephrol Dial Transplant patients in the left decubitus position. Early and atrial peak 1999; 14 [Suppl 5] filling velocities (VmaxE and VmaxA) were measured and their ratio (E/A) was calculated. Early deceleration time and isovolumic relaxation time (IVRT) were measured too. Reply LVH ( left ventricular mass index 110 g/m2 for women and 135 g/m2 for men) was detected in 25 (78.1%) patients. Sir, Ejection fraction was 59.6±7.55%. VmaxE was 0.63±0.13 In their letter Shutov et al. raise the question whether the m/s (control 0.71±0.13 m/s, P=0.02), VmaxA 0.65±0.19 E/A ratio gives a correct estimate of left ventricular diastolic m/s (control 0.48±0.11 m/s, P<0.001) and E/A 1.02±0.31 function in patients with chronic renal failure, if chronic (control 1.51±0.28, P<0.001). E/A ratio <1.0 was detected anaemia coexists. Our editorial comment focused on the in 12 (37.5%) patients. Multiple regression analysis (indedifferent types of morphology in left ventricular hypertrophy pendent variables were age, gender, body mass index, left (LVH), with special regard to LVH in end-stage renal disease ventricular mass index, serum creatinine and haemoglobin (ESRD) [1]. Alterations in diastolic function due to LVH concentration) showed an inverse correlation between haehave not yet been extensively analysed in the specific populamoglobin concentration and VmaxE (P=0.02). There was tion of patients with ESRD. Thus, possible effects of anaemia no significant relationship between VmaxA and haemoglobin on diastolic function cannot be ruled out. (P=0.86) [R2=0.39]. In this connection the E/A ratio would Shutov et al. present echocardiographic data of 32 patients increase and would not reflect the real degree of diastolic with chronic renal insufficiency with a wide range of serum dysfunction in patients with CRF and anaemia. Diastolic creatinine and haemoglobin concentrations in comparison to dysfunction in patients with CRF is a combination of 18 controls. They found a significant reduction of E/A ratio relaxation and compliance abnormalities. Echocardiographic in their patients pointing to an abnormal diastolic filling of indices are strongly dependent on pre-load [2] and an increase the left ventricle. Since the maximal inflow velocity of passive in atrial pressure can increase early diastolic filling and diastolic filling (VmaxE) is inversely correlated to hemoaccelerate relaxation [3]. However, IVRT was significantly globin level (but not the maximal inflow velocity of atrial higher in these patients than in the control group diastolic filling, VmaxA), they conclude that E/A ratio (108.9±26.9 vs 72.6±16.2 ms, respectively, P<0.001) and overestimates diastolic function in anaemic patients with there was a positive correlation with LVMI (P=0.04) chronic renal failure (CRF). [R2=0.36 ]. Unfortunately, Shutov et al. do not report the correlation It is known that anaemia is a strong predictor of developcoefficient for haemoglobin concentration and VmaxE. ment of LVH and morbidity and mortality in end-stage renal Therefore the importance of such an association cannot be disease [4]. The recent practice guidelines for treatment of judged. Furthermore, if the E/A ratio for estimating diastolic anaemia in chronic renal failure recommended a target haemoglobin of 11–12 g/dl [5]. However, this target is lower function is the matter of debate, the correlation between