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Published on: October 20, 2016
Assessment of Global Longitudinal Strain in Patients Receiving Renal Replacement Therapy With Preserved Left
Marta Obremska1, Maciej Szymczak2, Katarzyna Madziarska2
1Department of Emergency Medical Services ,Wrocław Medical University, Wrocław, Poland; Centre of Heart Diseases University Hospital, Wrocław, Poland.
Insights
Nearly half of patients on renal replacement therapy (RRT) show impaired left ventricular systolic function, even with normal ejection fraction. Long-term hemodialysis (HD) exceeding 28 months significantly increases this risk.
Area of Science:
- Cardiology
- Nephrology
Background:
- Patients on renal replacement therapy (RRT) face elevated cardiovascular mortality.
- Global longitudinal strain (GLS) is a sensitive predictor of cardiovascular mortality, surpassing LV ejection fraction (LVEF).
Purpose of the Study:
- To determine the prevalence of impaired GLS in RRT patients with preserved LVEF.
- To identify clinical factors associated with GLS impairment in this population.
Main Methods:
- 108 RRT patients with preserved LVEF and no prior cardiac disease were assessed.
- Echocardiogram parameters including GLS, lab results, diabetes, hypertension, hemodialysis (HD) duration, and kidney transplant (KTx) time were analyzed.
- Impaired GLS was defined as ≥-18%; multivariate logistic regression identified related factors.
Main Results:
- 45% of the 108 RRT patients exhibited impaired GLS (≥-18%).
- A hemodialysis duration exceeding 28 months was identified as a significant risk factor for impaired GLS.
- ROC analysis confirmed 28 months of HD as a cutoff for predicting impaired GLS.
Conclusions:
- Left ventricular systolic dysfunction, indicated by GLS ≥-18%, affects approximately 45% of RRT patients with preserved LVEF and no heart disease history.
- Hemodialysis duration longer than 28 months substantially elevates the risk of GLS impairment in RRT patients.
Background:
Patients with chronic kidney disease, including those on renal replacement therapy (RRT), have higher cardiovascular mortality. Global longitudinal strain (GLS) detects subtle changes in the left ventricle (LV) and constitutes a more sensitive predictor of cardiovascular mortality than the LV ejection fraction (LVEF). The aim of this study was to assess the prevalence of impaired GLS among patients on RRT with preserved LVEF. We also aimed to identify the possible clinical factors responsible for GLS impairment.
Methods:
A total of 108 patients on RRT with preserved LVEF and no history of cardiac disease were evaluated. We assessed echocardiogram parameters with a calculation of GLS, laboratory parameters, presence of diabetes, hypertension, duration of hemodialysis (HD), and the time after kidney transplantation (KTx). An impaired GLS value was set at ≥-18%. The multivariate stepwise logistic regression analysis was used to identify the factors related to impaired GLS.
Results:
Among 108 patients aged 58.5 ± 13.5 on RRT with preserved LVEF, 45% had GLS ≥-18% (62% on HD, 39% after KTx). The ROC analysis revealed that the cutoff point for the predicted GLS ≥-18% by HD duration was more than 28 months (0.75 [95% CI 0.66-0.84]; P < .001). In multivariate stepwise logistic regression analysis, a duration of HD longer than 28 months was associated with GLS ≥-18%.
Conclusions:
About 45% patients on RRT, despite preserved LVEF and no history of heart diseases, had LV systolic dysfunction defined as GLS ≥-18%. HD longer than 28 months significantly increases the risk of GLS impairment in patients on RRT.
