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Prevalence of left ventricular systolic dysfunction in pre-dialysis and dialysis patients with preserved left
Liselotte C R Hensen1, Kathleen Goossens1, Victoria Delgado1
1Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands.
Insights
Heart failure risk is high in chronic kidney disease (CKD) patients with preserved ejection fraction. Impaired left ventricular global longitudinal strain (GLS) in these CKD patients indicates a higher risk of heart failure hospitalization and death.
Area of Science:
- Cardiology
- Nephrology
- Echocardiography
Background:
- Patients with chronic kidney disease (CKD) face elevated cardiovascular risks, particularly heart failure (HF).
- Left ventricular (LV) systolic dysfunction, defined by reduced ejection fraction, is linked to poor prognosis.
- HF symptoms can occur in CKD patients with preserved LVEF, necessitating advanced diagnostic methods.
Purpose of the Study:
- To assess the prevalence of impaired LV global longitudinal strain (GLS) in CKD patients with preserved LVEF.
- To investigate the prognostic implications of impaired LV GLS in this patient subgroup.
Main Methods:
- Evaluated 200 pre-dialysis and dialysis patients (CKD stages 3b-5) with preserved LVEF (≥50%).
- Defined impaired LV GLS as ≤15.2% using two-dimensional speckle tracking echocardiography.
- Monitored patients for a median of 33 months for renal transplantation, HF hospitalization, and all-cause mortality.
Main Results:
- Impaired LV GLS (≤15.2%) was found in 32% of CKD patients with preserved LVEF.
- Patients with impaired LV GLS had significantly higher rates of HF hospitalization and all-cause mortality.
- A significant association was observed between impaired LV GLS and adverse cardiovascular outcomes (log-rank P = 0.018).
Conclusions:
- Impaired LV GLS is prevalent in pre-dialysis and dialysis patients with preserved LVEF.
- Preserved LVEF with impaired LV GLS identifies CKD patients at increased risk for HF hospitalization and mortality.
Aims:
Patients with chronic kidney disease (CKD) have an excess of cardiovascular morbidity and mortality, with heart failure (HF) being particularly frequent. Reduced left ventricular ejection fraction (LVEF) defines left ventricular (LV) systolic dysfunction and is associated with poor prognosis. However, CKD patients may have HF symptoms with preserved LVEF. In this subgroup of patients, two-dimensional speckle tracking echocardiography can detect LV systolic dysfunction by analysing LV myocardial deformation. The present study evaluated the prevalence of impaired LV global longitudinal strain (GLS) in CKD patients with preserved LVEF and its prognostic consequences.
Methods And Results:
Overall, 200 pre-dialysis and dialysis patients (65% men, mean age 60 ± 14 years) with CKD stage 3b-5 and preserved LVEF (≥50%) were evaluated. Left ventricular systolic dysfunction despite preserved LVEF was defined by LV GLS ≤15.2% (cut-off value derived from two standard deviations below the mean value of individuals without structural heart disease). Impaired LV GLS (≤15.2%) despite preserved LVEF was observed in 32% of patients. During a median follow-up of 33 months (interquartile range 17-62 months), 47% of patients underwent renal transplantation, 9% were admitted with HF, and 28% died. Patients with LV GLS ≤15.2% showed significantly worse cumulative event-free survival rates of the combined endpoint of HF hospitalization and all-cause mortality compared to patients with LV GLS >15.2% (log-rank P = 0.018).
Conclusion:
The prevalence of impaired LV GLS despite preserved LVEF in pre-dialysis and dialysis patients is relatively high. Patients with preserved LVEF but impaired LV GLS have an increased risk of HF hospitalization and all-cause mortality.
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