Incremental value of global longitudinal strain in prediction of all-cause mortality in predialysis and dialysis chronic kidney disease patients

Valocikova, I; Vachalcová, Marianna; Valočík, Gabriel; Kurečko, Marián; Dvoroznakova, M; Mitro, Peter; Cocherova, Jozefina; Bujnakova, Stanislava Buday; Holoubek, Dusan

doi:10.1007/s00508-016-0978-9

Cited by 8 publications

(8 citation statements)

References 27 publications

(27 reference statements)

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“…Third, the major finding of this study is that a worse longitudinal systolic deformation reflected by a low GLS (≤15.2%) is an independent and significant predictor for heart failure hospitalization and death over a median follow‐up of 33 months; this association was independent of known cardiac risk factors and other established echocardiographic measures commonly used in clinical practice, such as LVEF, indexes of LV diastolic dysfunction (as defined by lower E' and higher E/E' ratio), and LV mass index. The results of the present study are entirely consistent with and build on prior literature on the predictive value of GLS in CKD patients with reduced or preserved LVEF ( Table ) …”

Section: Studies Addressing the Relationship Between Global Longitudisupporting

confidence: 91%

“…in patients with hypertrophic cardiomyopathy the LVEF may be normal or even supernormal at a stage when systolic function is markedly reduced) and as a predictor of mortality and cardiovascular adverse events in various clinical settings . In CKD, GLS has been shown to have superior prognostic value compared with LVEF in predicting cardiovascular and all‐cause mortality …”

Section: Studies Addressing the Relationship Between Global Longitudimentioning

confidence: 99%

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Prognostic significance of global longitudinal strain in chronic kidney disease: the evidence is building

Ikonomidis

Andreou

Parissis

et al. 2017

European J of Heart Fail

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This article refers to 'Prevalence of left ventricular systolic dysfunction in pre-dialysis and dialysis patients with preserved left ventricular ejection fraction' by L.C.R. Hensen et al., published in this issue on pages 560-568.Chronic kidney disease (CKD) is a major health burden affecting roughly 11% of the population with a disproportionally increased propensity to develop cardiovascular disease and events. 1 CKD perpetuates systemic inflammation and oxidative stress, well-known instigators in cardiovascular disease. Proposed mechanisms by which renal dysfunction causes cardiac dysfunction include uraemic toxins, altered levels of renal endocrine factors, and haemodynamic overload. There is mounting evidence to support that CKD patients have an accelerated disease process with premature atherosclerosis, calcification, and cardiac remodelling resulting in left ventricular (LV) hypertrophy and diastolic dysfunction in early stages of the disease. LV systolic function when measured by LV ejection fraction (LVEF) is often preserved. We have a limited understanding of how to use echocardiographic parameters to risk stratify these patients. Although the relative risk of adverse events and death increases with decreasing estimated glomerular filtration rate and increasing proteinuria, patients within the same CKD classification may have very different absolute risks, while there is substantial overlap between the categories. In patients with heart failure and preserved LVEF, CKD is independently associated with increased cardiac remodelling (high LV mass, impaired diastolic relaxation), significantly worse cardiac mechanics (impaired LV longitudinal, left atrial, and right ventricular free wall strain), and worse outcome. 2,3 However, the role of CKD in patients with heart failure and preserved LVEF remains controversial as it was recently reported that although CKD is more common among these patients, it is less important with a weaker association and a less discriminatory power for mortality compared to heart failure with reduced or mildly reduced LVEF. 4 The opinions expressed in this article are not necessarily those of the Editors of the European Journal of Heart Failure or of the European Society of Cardiology.

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Section: Studies Addressing the Relationship Between Global Longitudisupporting

confidence: 91%

Section: Studies Addressing the Relationship Between Global Longitudimentioning

confidence: 99%

Prognostic significance of global longitudinal strain in chronic kidney disease: the evidence is building

Ikonomidis

Andreou

Parissis

et al. 2017

European J of Heart Fail

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“…32,33 Also, GLS seems to be an independent marker of systolic dysfunction, heart failure, and mortality in patients with CKD and ESRD. 34,35 The high correlation coefficient between VRLN and GLS suggests that myocardial fibrosis might also play an important role in the impairment of systolic strain and is consistent with findings in hypertensive patients. 36 Through measuring VRLN, clinicians might be able to detect cardiac dysfunction earlier than the reduction of LVEF and strain.…”

Section: Discussionsupporting

confidence: 82%

“…VRLN was also independently negatively correlated with GLS reduction, which was a good predictor of mortality and major adverse cardiac events in a variety of cardiomyopathies 32,33 . Also, GLS seems to be an independent marker of systolic dysfunction, heart failure, and mortality in patients with CKD and ESRD 34,35 . The high correlation coefficient between VRLN and GLS suggests that myocardial fibrosis might also play an important role in the impairment of systolic strain and is consistent with findings in hypertensive patients 36 .…”

Section: Discussionsupporting

confidence: 73%

Texture Analysis of Native T1 Images as a Novel Method for Noninvasive Assessment of Uremic Cardiomyopathy

Zhou

et al. 2021

Magnetic Resonance Imaging

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Background: Noncontrast cardiac T 1 times are increased in dialysis patients which might indicate fibrotic alterations in uremic cardiomyopathy. Purpose: To explore the application of the texture analysis (TA) of T 1 images in the assessment of myocardial alterations in dialysis patients. Study Type: Case-control study. Population: A total of 117 subjects, including 22 on hemodialysis, 44 on peritoneal dialysis, and 51 healthy controls. Field Strength: A 3 T, steady-state free precession (SSFP) sequence, modified Look-Locker imaging (MOLLI). Assessment: Two independent, blinded researchers manually delineated endocardial and epicardial borders of the left ventricle (LV) on midventricular T 1 maps for TA. Statistical Tests: Texture feature selection was performed, incorporating reproducibility verification, machine learning, and collinearity analysis. Multivariate linear regressions were performed to examine the independent associations between the selected texture features and left ventricular function in dialysis patients. Texture features' performance in discrimination was evaluated by sensitivity and specificity. Reproducibility was estimated by the intraclass correlation coefficient (ICC). Results: Dialysis patients had greater T 1 values than normal (P < 0.05). Five texture features were filtered out through feature selection, and four showed a statistically significant difference between dialysis patients and healthy controls. Among the four features, vertical run-length nonuniformity (VRLN) had the most remarkable difference among the control and dialysis groups (144 AE 40 vs. 257 AE 74, P < 0.05), which overlap was much smaller than Global T 1 times (1268 AE 38 vs. 1308 AE 46 msec, P < 0.05). The VRLN values were notably elevated (cutoff = 170) in dialysis patients, with a specificity of 97% and a sensitivity of 88%, compared with T 1 times (specificity = 76%, sensitivity = 60%). In dialysis patients, VRLN was significantly and independently associated with left ventricular ejection fraction (P < 0.05), global longitudinal strain (P < 0.05), radial strain (P < 0.05), and circumferential strain (P < 0.05); however, T 1 was not.

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“…Worsening eGFR correlates with the degree of DD as assessed by the E/e′ ratio . E/e′ ratio together with LV global longitudinal strain (LV GLS) is the most powerful echocardiographic predictors of CV events and mortality in dialysis patients . An E/e′ ratio > 15 is commonly used to identify high LV filling pressures.…”

Section: Conventional Transthoracic Echocardiography (Tte)mentioning

confidence: 99%

Multi‐modality cardiac imaging in advanced chronic kidney disease

Ureche

Sascău

Țăpoi³

et al. 2019

Echocardiography

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Cardiovascular disease (CVD) is the leading cause of death worldwide and is particularly frequent among those with severe renal impairment. Early diagnosis and therapeutic intervention may help alleviate the burden of cardiovascular complication within this population. In the last years, advances have been made toward developing noninvasive imaging techniques that could offer better insight into the cardiac involvement in end‐stage renal disease (ESRD). Conventional transthoracic echocardiography remains the first‐line investigation used to assess cardiac function, but encompassing in our daily practice, the newer approaches such as speckle‐tracking imaging, cardiac computed tomography, or cardiac magnetic resonance can guide us to a more comprehensive understanding of CVD in ESRD. Given that patients with chronic kidney disease may not present with typical CVD symptoms, the amount of information brought by newer imaging techniques is crucial for an accurate diagnosis, risk stratification, and further management. The purpose of this review is to briefly summarize the specific applications of standard cardiac imaging techniques in patients with ESRD and to offer insight into the novel imaging modalities, highlighting the newest research in this field. By doing so, we aim to identify the most important imaging predictors of clinical outcomes in this population.

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Incremental value of global longitudinal strain in prediction of all-cause mortality in predialysis and dialysis chronic kidney disease patients

Cited by 8 publications

References 27 publications

Prognostic significance of global longitudinal strain in chronic kidney disease: the evidence is building

Prognostic significance of global longitudinal strain in chronic kidney disease: the evidence is building

Texture Analysis of Native T1 Images as a Novel Method for Noninvasive Assessment of Uremic Cardiomyopathy

Multi‐modality cardiac imaging in advanced chronic kidney disease

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