The impact of hemodialysis on segmental and global longitudinal myocardial strain
Shih-Han S Huang1, Lisa E Crowley2, Helen J Jefferies2
1Department of Renal Medicine, Royal Derby Hospital, NHS Foundation Trust, Derby, United Kingdom; Department of Medicine, Division of Nephrology, Western University and London Health Sciences Centre, London, Ontario, Canada; Department of Medical Biophysics, Western University, London, Ontario, Canada.
Insights
Hemodialysis (HD) patients show altered ventricular strain, indicating cardiac injury. Abnormal segmental strain predicts mortality risk in these patients.
Area of Science:
- Cardiology
- Medical Imaging
- Nephrology
Background:
- Strain analysis from echocardiography assesses ventricular function.
- Hemodialysis (HD) imposes circulatory stress, potentially impacting cardiac function.
- Investigating HD-induced stress on ventricular function using strain analysis is crucial.
Purpose of the Study:
- To examine the relationship between HD-induced circulatory stress and ventricular function.
- To assess overall ventricular function using global longitudinal strain (GLS) and segmental strain distribution.
- To correlate strain values with patient demographics and survival outcomes.
Main Methods:
- Prospective observational study of 104 conventional HD patients.
- Echocardiography-derived GLS and segmental strain measured before and during HD.
- Comparison with healthy individuals and assessment of survival impact.
Main Results:
- HD patients exhibited significantly greater segmental strain values than healthy individuals (P < 0.001).
- Strain values remained largely stable during dialysis, except for the basal lateral segment.
- Abnormal segmental strain (>80% segments) was associated with a 4.3-fold increased mortality risk (P = 0.021).
- Negative correlation found between survival time and GLS in deceased patients (r = -0.30, P = 0.04).
Conclusions:
- Speckle tracking imaging-derived strain effectively quantifies HD-induced cardiac injury.
- Segmental strain abnormalities in the left ventricle's watershed area suggest vulnerability to demand ischemia.
- Strain analysis is a valuable tool for risk stratification in HD patients.
Background:
Strain analysis derived from the analysis of speckle tracked imaging echocardiography can be used to examine ventricular contractile functions. In this study, we examined the relationship of hemodialysis (HD)-induced circulatory stress with overall ventricular function assessed according to global longitudinal strain (GLS) and segmental distribution of strain.
Methods:
This prospective observational study included 104 conventional HD patients at Royal Derby Hospital. Averaged values of segmental and GLS were determined from the echocardiography of these patients before and at peak dialysis. These values were compared with the reference values of healthy individuals, correlated with their demographic characteristics, and the effect on survival was assessed.
Results:
The global strain value was -11.5% ± 4.42, and the segmental strain values were significantly greater in HD patients than in healthy individuals by 2.7%-9.8% (P < 0.001). The strain values were not significantly different before dialysis and at peak dialysis (P > 0.05), except within the basal lateral segment (P = 0.01). The adjusted hazard ratio for mortality was 4.3 (95% confidence interval, 1.2-14.9; P = 0.021) when > 80% of the segments exhibited more than the mean of segmental strain values. For the 46 patients who died, there were statistically significant negative correlations between survival time and GLS (r = -0.30; P = 0.04).
Conclusions:
Global and segmental strain measured using speckle tracked imaging provides information relating to the effects of HD-induced cardiac injury. The segmental strain abnormalities in the watershed area of the left ventricle suggest a higher degree of vulnerability to HD-induced demand ischemia.
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