Speckle Tracking Echocardiography Detects Uremic Cardiomyopathy Early and Predicts Cardiovascular Mortality in ESRD

Kramann, Rafael; Erpenbeck, Johanna; Schneider, Rebekka K.; Röhl, Anna Bettina; Gesenhues, Jonas; Brandenburg, Vincent; Diepen, Merel van; Dekker, Friedo W.; Marx, Nicole; Floege, Jürgen; Becker, Michael; Schlieper, Georg

doi:10.1681/asn.2013070734

Cited by 95 publications

(101 citation statements)

References 67 publications

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“…Furthermore, no significant differences in GLS were observed when comparing CKD, dialysis, and transplanted patients. These findings are consistent with studies that showed less negative LV longitudinal strain in ESRD patients than in controls [10, 13, 24], but are at variance with a previous study that reported better GLS in ESRD patients on dialysis treatment than in those with CKD not requiring dialysis yet [25]. We have no reliable explanations of this discrepancy, since in both studies, volume status was similar in non-dialysis and dialysis patients, thus ruling out the occurrence of chronic fluid overload as the cause of worse GLS in the group of CKD patients not undergoing extracorporeal treatment.…”

Section: Discussionsupporting

confidence: 93%

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Impaired Left Ventricular Global Longitudinal Strain among Patients with Chronic Kidney Disease and End-Stage Renal Disease and Renal Transplant Recipients

et al. 2018

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Background: Although heart failure is the most prevalent cardiovascular disease associated with adverse outcome in chronic kidney disease (CKD) and after kidney transplantation, left ventricular (LV) systolic function is often preserved in renal patients. The aim of this study was to evaluate global longitudinal strain (GLS), which is reportedly a more accurate tool for detecting subclinical LV systolic dysfunction, in patients with various degrees of renal function impairment, including kidney transplant recipients (KTRs). Methods: This prospective study evaluated demographic, clinical, and ultrasound data, including the assessment of LV GLS and mitral E peak velocity and averaged ratio of mitral to myocardial early velocities (E/e’), of 70 consecutive renal patients (20 with stage 2–4 CKD, 25 with end-stage renal disease on hemodialysis [HD], and 25 KTRs). All patients had an LV ejection fraction ≥50% and no history of heart failure or coronary artery disease. We used multivariable logistic analysis to assess the risk of compromised GLS. One hundred and twenty control subjects with or without hypertension served as controls. Results: A compromised GLS <–18% was shown in 55% of patients with stage 2–4 CKD, 60% of HD patients, and 28% of KTRs, while it was 32% in hypertensive controls and 12% in non-hypertensive controls (p < 0.0001). Patients with HD had higher systolic pressure and a significantly greater prevalence of increased LV mass and diastolic dysfunction. In renal patients, E/e’ (p = 0.025), and LV mass index (p = 0.063) were independent predictors of compromised GLS at logistic regression analysis. E/e’, systolic artery pressure, and LV mass also exhibited the greatest areas under the curve on receiver operating characteristic analysis to identify a compromised GLS. Conclusions: Renal disease proved to be associated with early and subclinical impairment of LV systolic function, which persists after starting dialysis and even in spite of successful kidney transplantation. An increased E/e’ resulted to be the most powerful independent predictor of abnormal GLS.

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Section: Discussionsupporting

confidence: 93%

“…Abnormal GLS was independently associated with both all-cause and CV mortality also in patients with CKD and those undergoing hemodialysis (HD) [13, 14]. …”

Section: Introductionmentioning

confidence: 99%

Impaired Left Ventricular Global Longitudinal Strain among Patients with Chronic Kidney Disease and End-Stage Renal Disease and Renal Transplant Recipients

et al. 2018

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“…The E-toe9 ratio is now a standard component of diastolic assessment (25) and particularly useful in differentiating normal from pseudonormal diastolic function. Additionally, recent studies have illustrated the prognostic utility of using speckle tracking echocardiography to quantify systolic function in patients with predialysis CKD (26) and ESRD (27,28). Thus, the less striking associations observed for EF could be interpreted as a limitation of the conventional evaluation of systolic function in patients with normal EF.…”

Section: Discussionmentioning

confidence: 99%

Associations of Conventional Echocardiographic Measures with Incident Heart Failure and Mortality: The Chronic Renal Insufficiency Cohort

Dubin

Deo

Bansal

et al. 2016

CJASN

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Background and objectives Heart failure is the most frequent cardiac complication of CKD. Left ventricular hypertrophy is common and develops early in CKD, but studies have not adequately evaluated the association of left ventricular mass index with heart failure incidence among men and women with CKD.Design, setting, participants, & measurements We evaluated echocardiograms of 2567 participants without selfreported heart failure enrolled in the Chronic Renal Insufficiency Cohort Study. Two-dimensional echocardiograms were performed at the year 1 study visit and interpreted at a central core laboratory. Left ventricular mass index was calculated using the linear method, indexed to height 2.7 , and analyzed using sex-specific quartiles. The primary outcomes of incident heart failure and all-cause mortality were adjudicated over a median of 6.6 (interquartile range, 5.7-7.6) years.Results Among 2567 participants, 45% were women, and 54% were nonwhite race; mean (SD) age was 59611 years old, and mean eGFR was 44617 ml/min per 1.73 m 2 . During a median follow-up period of 6.6 years, 262 participants developed heart failure, and 470 participants died. Compared with participants in the first quartile of left ventricular mass index, those in the highest quartile had higher rates of incident heart failure (hazard ratio, 3.96; 95% confidence interval, 1.96 to 8.02) and mortality (hazard ratio, 1.86; 95% confidence interval, 1.22 to 2.85), even after adjustment for B-type natriuretic peptide, troponin T, mineral metabolism markers, and other cardiovascular disease risk factors. Those in the lowest quartile of ejection fraction had higher rates of incident heart failure (hazard ratio, 3.01; 95% confidence interval, 1.94 to 4.67) but similar mortality rates (hazard ratio, 1.18; 95% confidence interval, 0.89 to 1.57) compared with those in the highest quartile. Diastolic dysfunction was not significantly associated with heart failure or death.Conclusions Among persons with CKD and without history of cardiovascular disease, left ventricular mass index is strongly associated with incident heart failure, even after adjustment for major cardiovascular risk factors and biomarkers.

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“…It has been reported in a cohort of 241 HD patients that an increase of 1 ms -1 of PWV is associated with an adjusted HR of 1.39 (95% CI 1.19-1.62) for all-cause mortality [21] . The recognition of GLS as an important prognostic risk factor has only recently emerged [4,5,16,22] . In 88 stable HD patients with a mean follow-up of 25 ± 9.9 months, Liu et al [4] reported that a less negative GLS (performed during dialysis) was associated with a 3.57 times higher all-cause mortality (95% CI 1.41-9.04, p = 0.01).…”

Section: Discussionmentioning

confidence: 99%

Novel Approach to Cardiovascular Outcome Prediction in Haemodialysis Patients

Chiu

Abidin²,

Johnstone³

et al. 2016

Am J Nephrol

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Background: Cardiovascular mortality is high in haemodialysis (HD) patients. Arterial stiffness and global longitudinal strain (GLS) are important non-atheromatous cardiovascular risk predictors. No study has encompassed both parameters in a combined model for prediction of outcomes in HD patients. This is important because left ventricular (LV) dysfunction can result from fibrotic remodelling secondary to increased arterial stiffness. Methods: Two hundred and nineteen HD patients had pulse wave velocity (PWV) and echocardiography (including GLS) assessments. Patients were followed-up until death, transplantation or November 16, 2015, whichever happened first. Pearson's correlation coefficient was used to determine factors associated with PWV and GLS. A multivariable Cox regression model investigated factors associated with all-cause, cardiac death and events. Results: One hundred and ninety eight HD patients had full datasets (median age 64.2, 68.7% males) with a mean LV ejection fraction (LVEF) of 61.7 ± 10.1% and GLS -13.5 ± 3.3%; 51% had LV hypertrophy. Forty eight deaths (15 cardiac) and 44 major cardiac events occurred during a median follow-up of 27.6 (25th-75th percentile, 17.3-32.7) months. In separate survival models, PWV and GLS were independently associated with all-cause mortality; however, in a combined model, LV mass indexed to height^2.7 (LVMI/HT^2.7; adjusted hazard ratio (HR) 1.02, 95% CI 1.00-1.04) and PWV (adjusted HR 1.23, 95% CI 1.03-1.47) were significant. PWV was neither associated with cardiac death nor associated with related cardiac events. However, GLS was associated with cardiac death (adjusted HR 1.24, 95% CI 1.00-1.54) and cardiac events (adjusted HR 1.13, 95% CI 1.03-1.25). Conclusions: PWV and LVMI/HT^2.7 were superior to GLS in prediction of all-cause mortality. However, GLS was associated with cardiac death and events even when accounting for LVEF and LVMI/HT^2.7.

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Speckle Tracking Echocardiography Detects Uremic Cardiomyopathy Early and Predicts Cardiovascular Mortality in ESRD

Cited by 95 publications

References 67 publications

Impaired Left Ventricular Global Longitudinal Strain among Patients with Chronic Kidney Disease and End-Stage Renal Disease and Renal Transplant Recipients

Impaired Left Ventricular Global Longitudinal Strain among Patients with Chronic Kidney Disease and End-Stage Renal Disease and Renal Transplant Recipients

Associations of Conventional Echocardiographic Measures with Incident Heart Failure and Mortality: The Chronic Renal Insufficiency Cohort

Novel Approach to Cardiovascular Outcome Prediction in Haemodialysis Patients

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