Speckle-tracking echocardiography in comparison with ejection fraction for prediction of cardiovascular mortality in patients with end-stage renal disease

Abstract

Background Cardiovascular disease is the major cause of death in end-stage renal disease (ESRD). To develop better means to assess cardiovascular risk in these patients, we compared conventional echocardiography-derived left ventricular ejection fraction (EF) with the novel method of 2D speckle-tracking echocardiography to determine cardiac strain. Methods Predictive performances of conventional EF and speckle-tracking echocardiography-derived global longitudinal strain (GLS) were compared using receiver-operator curve (ROC) analyses and calibration by calibration plots. We also took into account other known cardiovascular risk factors through multivariable logistic regression analysis. Results The study comprised 171 ESRD patients (mean age 64 years, 64% male) on maintenance dialysis therapy (93% haemodialysis, 7% peritoneal dialysis) for an average period of 39 months. During 2.1 years of follow-up, 42 patients (25%) died from cardiovascular disease. ROC analysis of GLS resulted in an area under the curve of 0.700 [95% confidence interval (CI) 0.603–0.797] compared with an area under the curve of EF of 0.615 (95% CI 0.514–0.716) (P = 0.059 for difference). The total absolute deviation between predicted and observed outcome frequencies obtained by calibration plots were 13.8% for EF compared with only 6.4% for GLS. Best results of ROC analysis (area under the curve = 0.759; P = 0.06), calibration and goodness-of-fit (χ2 = 28.34, P ≤ 0.0001, R2 = 0.25) were achieved for GLS added to a baseline model consisting of known cardiovascular risk factors in a multivariate regression analysis. Conclusions In summary, in chronic dialysis patients, GLS is a more precise predictor of cardiovascular mortality than conventional echocardiography-derived EF.

Echocardiogram screening in pediatric dialysis and transplantation

“…A less negative value is indicative of worse systolic LV function. GLS is a sensitive measure of systolic function and has recently been identified in adult KF as a more precise predictor of cardiovascular mortality than ejection fraction [ 46 ]. Regional strain can be assessed by STE and has been used to help define mechanical dyssynchrony [ 30 ].…”

Assessment of the Prognostic Value of MRI Left Ventricular Global Function Index (LVGFI) in Patients With End‐Stage Renal Disease Under Maintenance Dialysis

“…7,8 Currently, echocardiography is a routine method for cardiac measurement, and LVEF has been recommended as an indicator for risk stratification in patients with ESRD. 9 However, LVEF as a predictor of MACE in ESRD patients, has some limitations, including failure to account for differences in left ventricular mass and size, which have been shown to be prognostic in several CVDs, including uremic cardiomyopathy. [10][11][12] Moreover, early cardiac impairment in patients with ESRD is manifested as diastolic dysfunction with preserved ejection fraction, and LVEF does not reflect this early cardiac impairment.…”

Can myocardial work help in the therapy of resistant hypertension?

“… 3 Despite this limitation GLS was proven to be an important predictor of cardiovascular (CV) events in hemodialysis patients. 4 …”

“…3 Despite this limitation GLS was proven to be an important predictor of cardiovascular (CV) events in hemodialysis patients. 4 The importance of GLS in arterial hypertension is well established and it has been even involved in the guidelines for imaging in hypertensive patients. 5 It was also demonstrated that GLS has a significant predictive value, that was higher of LVEF for prediction of CV events.…”

“…However, GLS is not completely load independent parameter and study involved hemodialysis patients showed that GLS was different in the same patients before and after dialysis 3 . Despite this limitation GLS was proven to be an important predictor of cardiovascular (CV) events in hemodialysis patients 4 …”