Left Ventricular Systolic Strain in Chronic Kidney Disease and Hemodialysis Patients

Abstract

Background: The impact of chronic kidney disease (CKD) and hemodialysis on heart function is not fully understood. We aimed to investigate the influence of different stages of CKD and maintenance hemodialysis on heart function. Methods: One hundred fifty-three patients were categorized into 3 subgroups [56 without CKD as controls; 37 with moderate-advanced CKD, stages 3, 4 or 5, and 60 with end-stage renal disease (ESRD) undergoing maintenance hemodialysis]. Left ventricular (LV) function was assessed by conventional echocardiography and 2-dimensional speckle-tracking echocardiography with strain analysis (2D strain analysis). Results: There was no significant difference of gender, age and LV ejection fraction among groups. Compared with controls, global peak systolic longitudinal strain (GS_l), circumferential strain and strain rate were decreased in the CKD group. Along with the decline of renal function, GS_l deteriorated. Moreover, compared with moderate-advanced CKD patients, GS_l, circumferential strain and strain rate were better in ESRD group receiving maintenance hemodialysis. Conclusions: Worsening renal function was associated with a reduction of systolic function, and could be quantified by 2D strain analysis. The hemodialysis patients have better LV systolic function than the moderate-advanced CKD patients.

Association of Left Ventricular Longitudinal Strain with Mortality among Stable Hemodialysis Patients with Preserved Left Ventricular Ejection Fraction

“…As previously described, all hemodialysis patients received an echocardiographic examination during the halfway point of the hemodialysis session (the second or third hour of each session) (12). According to the recommendations of the American Society of Echocardiography (18), quantifications of LV mass index (LVMi), LVEF, and left atrial volume index (LAVi) were performed, and LVH was defined as LVMi .115 g/m 2 for men and .95 g/m 2 for women.…”

“…The ratio of early transmitral flow to early diastolic mitral annular velocity (E/e') was calculated from the average of the septal and lateral e'. Two-dimensional grayscale imaging in three standard apical views (i.e., apical 4-chamber, apical 2-chamber, and apical long-axis) for three cardiac cycles were acquired and stored digitally with a frame rate of 50-90 frames per second for subsequent off-line analysis (11,12).…”

“…To evaluate the fluid status of hemodialysis patients, the inferior vena cava (IVC) diameter was measured twice at the end of expiration in a sub-xiphoid location (12,19), and the average of the measured end-expiratory IVC diameter was defined as IVCe.…”

“…The more negative value of GLS, the better the LV function is. Compared with LVEF, GLS is a more sensitive, objective, and reproducible modality for assessing cardiac functions, even among HF patients with preserved LVEF and CKD patients (11)(12)(13)(14). In the general population, GLS has proven to be a prognostic predictor (13,14).…”

“…In the general population, GLS has proven to be a prognostic predictor (13,14). Reports suggest that subclinical LV systolic dysfunction, as indicated by GLS, is present in CKD and ESRD patients (8,12,15). However, there are few data on the prognostic role of GLS in hemodialysis patients.…”