Ratio of Early Mitral Inflow Velocity to the Global Diastolic Strain Rate and Global Left Ventricular Longitudinal Systolic Strain Predict Overall Mortality and Major Adverse Cardiovascular Events in Hemodialysis Patients

Abstract

Background. The ratio of early mitral inflow velocity to the global diastolic strain rate (E/E’sr) and global longitudinal systolic strain (GLS) of the left ventricle (LV) are emerging indices of diastolic and systolic functions, respectively, for the LV. Their prognostic significance in the prediction of mortality and cardiovascular (CV) outcomes remains underexplored in hemodialysis (HD) patients. Methods. This prospective study included 190 maintenance HD patients. The E/E’sr ratio and GLS were assessed using two-dimensional speckle tracking echocardiography. The clinical outcomes included overall mortality, CV mortality, and major adverse cardiovascular events (MACE). The associations between the E/E’sr ratio, GLS, and clinical outcomes were evaluated using multivariate Cox regression analysis. The incremental values of the E/E’sr ratio and GLS in outcome prediction were assessed by χ2 changes in Cox models. Results. Over a median follow-up period of 3.7 years, there were 35 overall deaths, 16 CV deaths, and 45 MACE. Impaired diastolic function with a higher E/E’sr ratio was associated with overall mortality (HR, 1.484; 95% CI, 1.201−1.834; p<0.001), CV mortality (HR, 1.584; 95% CI, 1.058–2.371; p=0.025), and MACE (HR, 1.205; 95% CI, 1.040−1.397; p=0.013) in multivariate adjusted Cox analysis. Worsening GLS was associated with overall mortality (HR, 1.276; 95% CI, 1.101−1.480; p=0.001), CV mortality (HR, 1.513; 95% CI, 1.088−2.104; p=0.014), and MACE (HR, 1.214; 95% CI, 1.103−1.337; p<0.001). The E/E’sr ratio and GLS had better outcome prediction than the E to early diastolic mitral annular velocity (E/E’) ratio and left ventricular ejection fraction (LVEF). Moreover, adding the E/E’sr ratio and GLS to Cox models containing relevant clinical and conventional echocardiographic parameters improved the prediction of overall mortality (p<0.001), CV mortality (p<0.001), and MACE (p<0.001). Conclusion. The E/E’sr ratio and GLS, as emerging indices of LV diastolic and systolic functions, significantly predict mortality and CV outcomes and outperform conventional echocardiographic parameters in outcome prediction in HD patients.

Left ventricular strain and left atrial strain are impaired during hemodialysis in children

“…20,21 The E/DSrE ratio improved the prediction of cardiovascular mortality and major adverse cardiovascular events in HD adult patients over clinical and conventional echocardiographic parameters alone. 6 In our study, intradialytic E/DSrE change was nonsigni cant. We observed progressive intradialytic Ds and DSrE impairment which was not associated with BV removal or BP change.…”

“…3,4 Left ventricular (LV) global longitudinal strain (GLS), mechanical dispersion index (MDI), and the ratio of early mitral in ow velocity (E) to global diastolic strain rate (Sr) in early diastole (E/DSrE) using 2-dimensional (2-D) speckle tracking echocardiography (STE) are risk markers of ventricular arrhythmia and sudden cardiac death in adult dialysis patients. 5,6 Data on cardiac strain imaging in children with ESRD and HD are limited to markers of systolic function. [7][8][9] In children on dialysis, retrospective longitudinal studies have demonstrated impaired GLS improved after kidney transplantation.…”

Frequency and risk factors of impaired left ventricular global longitudinal strain in patients with end-stage renal disease: a two-dimensional speckle-tracking echocardiographic study

“…Frequency and risk factors of impaired left ventricular global longitudinal strain in patients with end-stage renal disease: a two-dimensional speckle-tracking echocardiographic study 10 11 with advanced kidney disease compared to LVEF (5)(6)(7). Nonetheless, the question has arisen regarding what ESRD patients' factors are related to impaired LV systolic longitudinal strain.…”

Association between Reduced Serum Zinc and Diastolic Dysfunction in Maintenance Hemodialysis Patients

“…Around 87% of patients with end-stage renal disease (ESRD) have major structural abnormalities on echocardiography, of which left atrial (LA) dilation, left ventricular (LV) hypertrophy, and LV diastolic impairment are the most common findings [ 6 ]. Diastolic dysfunction is associated with adverse outcomes and is an underemphasized challenge in hemodialysis (HD) patients [ 7 ]. The early mitral inflow diastolic velocity (E) to average septal and lateral early diastolic mitral annular velocities (e’) ratio, as well as left atrial volume index (LAVI), are important indicators of diastolic dysfunction [ 8 ], and can reflect LV filling pressure; thus, they have prognostic implications in dialysis patients [ 9 , 10 ].…”