Prognostic Implications of Left Ventricular Global Longitudinal Strain in Predialysis and Dialysis Patients

Abstract

Chronic kidney disease (CKD) is a worldwide growing epidemic associated with an increased risk of cardiovascular morbidity and mortality. Left ventricular (LV) global longitudinal strain (GLS) is a measure of LV systolic function associated with prognosis in the general population. However, little is known about the association between LV GLS and survival in patients with CKD. The aim of the present study was to investigate the prognostic implications of LV GLS in predialysis and dialysis patients specifically. LV GLS was measured in a retrospective cohort of predialysis and dialysis patients (CKD stage 3b to 5) who underwent clinically indicated echocardiography between 2004 and 2015. Patients were divided into 4 groups according to quartiles of LV GLS: first quartile (LV GLS ≤10.6%, worst function), second quartile (LV GLS 10.7% to 15.1%), third quartile (LV GLS 15.2% to 17.8%), and fourth quartile (LV GLS ≥17.9%, best function). The primary end point was all-cause mortality. Of 304 patients (62 ± 14 years, 66% male), 65% were in predialysis and 35% in dialysis. During a median follow-up of 29 months (interquartile range 16 to 58 months), 34% of patients underwent renal transplantation and 36% died. Patients with LV GLS ≤10.6% showed significantly worse prognosis compared with the other groups (log-rank test, p <0.001). LV GLS ≤10.6% was significantly associated with increased risk of all-cause mortality (hazard ratio 2.18, 95% CI 1.17 to 4.06, p = 0.014) after correcting for age, gender, albumin levels, atrial fibrillation, and renal transplantation. In conclusion, in predialysis and dialysis patients, severely impaired LV GLS is independently associated with an increased risk of mortality.

Prevalence of left ventricular systolic dysfunction in pre‐dialysis and dialysis patients with preserved left ventricular ejection fraction

“…From an ongoing registry of pre‐dialysis and dialysis patients at the Leiden University Medical Centre, The Netherlands, patients with preserved LVEF (≥50%) and New York Heart Association functional class I–IV, assessed by transthoracic echocardiography performed during haemodynamic stable conditions, were selected. All patients were diagnosed with CKD stage 3b–5 according to the 2012 clinical practice guideline for the evaluation and management of CKD by Kidney Disease: Improving Global Outcomes (KDIGO) .…”

High-sensitive troponin T increase after hemodialysis is associated with left ventricular global longitudinal strain and ultrafiltration rate

“…In addition, higher ultrafiltration volumes may result in myocardial stunning [14][15][16] and show an impact on cTn levels. LV global longitudinal strain (GLS) -a marker of LV systolic function -is associated with poor prognosis and has been suggested to be a better prognostic indicator than conventional LV ejection fraction (EF) in patients with chronic kidney disease [17,18]. Therefore, the present study was to investigate (i) the change in circulating hs-cTnT levels with hemodialysis (HD); (ii) the relationship between changes in hs-cTnT levels and volume depletion and (iii) changes in LV deformation as assessed by two-dimensional (2D) strain echocardiography with HD.…”

Prolonged haemodialysis increases the risk of the impairment of global longitudinal strain in patient after kidney transplantation and a preserved ejection fraction of left ventricle

“…[15].In kidney transplant patients, according to various studies the value of GLS was -17 to -19%, because CKD patients with lower GLS were less frequently transplanted. In Hensen study, only 8% patients with GLS < 10.6% were transplanted, while 32% with GLS 10.7-15.1%; 49% with GLS 15.2-17.8%, and 47% with GLS > 17.9% [16].…”