Impact of hemodialysis, left ventricular mass and FGF-23 on myocardial mechanics in end-stage renal disease: a three-dimensional speckle tracking study

Abstract

Left ventricular (LV) hypertrophy and one of its inducers, the fibroblast growth factor-23 (FGF-23) were found to be associated with unfavourable outcome in end-stage renal disease (ESRD) patients. We sought to investigate the influence of hemodialysis (HD), increased LV mass and FGF-23 on LV mechanics using three-dimensional (3D) speckle tracking echocardiography. Forty-four ESRD patients on maintenance HD were examined just before and immediately after HD, and were compared to 44 normal controls (NC). Transthoracic 3D recordings were obtained using multi-beat reconstruction from 6 consecutive cardiac cycles. LV mass index (LVMi) was evaluated and 3D speckle tracking analysis was performed to calculate global longitudinal (GLS), circumferential (GCS), area (GAS) and radial (GRS) peak systolic strain. Serum FGF-23 levels were also measured. Strain values improved in all directions after HD [pre- vs. post-HD; GLS: -20(3) vs. -21(6), GCS: -20(4) vs. -22(7), GAS: -33(5) vs. -35(10), GRS: 50(12) vs. 53.5(20) %, all p < 0.01]. LVMi was remarkably increased in our patients [ESRD vs. NC; 136(46) vs. 71(8) g/m(2), p < 0.001]. Elevated FGF-23 levels were associated with increased LV mass (ρ = 0.581, p < 0.001). LVMi was inversely related to pre-HD GCS (ρ = 0.626, p < 0.001) and post-HD GCS (ρ = 0.761, p < 0.001), GAS (ρ = 0.534, p < 0.05) and GRS (ρ = -0.639, p < 0.01). Serum FGF-23 levels correlated with post-HD GAS (ρ = 0.513, p < 0.01) and GRS (ρ = -0.512, p < 0.05). HD treatment results in immediate improvement in all strain directions. Besides inducing LV hypertrophy, FGF-23 may play a role in the deterioration of LV mechanics in patients with ESRD.

Association of serum intact fibroblast growth factor 23 with left ventricular mass and different echocardiographic findings in patients on hemodialysis

“…They concluded from results that serum FGF23 level is independently associated with LVH; however, it is not a predictor for short-term prognosis (2-year follow-up). [22] In a recent study, Kovács and colleagues [23] by using three-dimensional speckle tracking echocardiography investigated the effects of FGF23 on LV mechanics in patients on hemodialysis and found that elevated FGF23 levels were associated with increased LV mass (ρ = 0.581, P < 0.001). Accordingly, Liu et al [24] examined the relationship between FGF23and LVH in 62 patients on continuous ambulatory peritoneal dialysis and 30 healthy controls [24] .…”

Strain and strain rate by speckle-tracking echocardiography correlate with pressure-volume loop-derived contractility indices in a rat model of athlete's heart

“…Superiority of speckle tracking-derived parameters in detecting subtle myocardial injury was suggested by numerous works not just in humans but also in animal models (12,15,16). Strain indices were shown to be able to sensitively and continually reflect the progression of heart failure as well (13).…”

Left ventricular strain analysis using cardiac magnetic resonance imaging in patients undergoing in‐centre nocturnal haemodialysis

“…Most studies have used echocardiography to measure cardiac strain among patients with renal disease, and have reported an association between strain and cardiovascular outcomes. [16][17][18][19] In comparison to echocardiography, cardiac MRI (CMR) has the benefit of being less operator-dependent, more reproducible, and better equipped to study circumferential strain. 11 The increased availability and standardization of CMR have lent itself to strain analysis in research and clinical use.…”