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Updated: Oct 8, 2025
Evaluation of Left Ventricular Structure and Function using 3D Echocardiography
Published on: October 28, 2020
Left ventricular structure and function in patients with chronic kidney disease assessed by 3D echocardiography: the
Jacob Christensen1,2, Nino Emanuel Landler3,4, Flemming Javier Olsen3
1Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Hellerup, Denmark. jacob.christensen.02@regionh.dk.
Insights
Cardiovascular disease worsens with declining kidney function. This study shows reduced left ventricular systolic function with lower eGFR and increased left ventricular mass with higher albuminuria in chronic kidney disease patients.
Area of Science:
- Cardiology
- Nephrology
- Medical Imaging
Background:
- Cardiovascular disease (CVD) is the primary cause of mortality in patients with chronic kidney disease (CKD).
- Understanding the cardiac implications of CKD progression is crucial for patient management.
- Previous studies have not extensively utilized 3-dimensional echocardiography (3DE) to assess left ventricular (LV) changes across CKD stages.
Purpose of the Study:
- To investigate the associations between adverse left ventricular (LV) changes and different stages of chronic kidney disease (CKD).
- To utilize 3-dimensional echocardiography (3DE) for detailed assessment of LV structure and function in CKD patients.
- To determine if these associations are independent of each other.
Main Methods:
- Participants were recruited from the Copenhagen CKD and Herlev-Gentofte CKD cohort studies.
- Patients were stratified by estimated glomerular filtration rate (eGFR) categories (G1+2, G3, G4+5) and albuminuria categories (A1, A2, A3).
- Echocardiograms were analyzed for LV mass index (LVMi), LV ejection fraction (LVEF), and global strain measures, with adjusted analyses performed.
Main Results:
- Reduced LVEF and global longitudinal strain (GLS) were observed with decreasing eGFR categories.
- Increased LV mass index (LVMi) and prevalence of LV hypertrophy were associated with increasing albuminuria severity.
- Adjusted analyses confirmed reduced LVEF in G3 CKD and increased LVMi in A3 albuminuria, independent of each other.
Conclusions:
- Declining kidney function (eGFR) is independently associated with impaired left ventricular systolic function.
- Increased albuminuria is independently associated with adverse changes in left ventricular mass.
- 3DE is a valuable tool for characterizing cardiac remodeling in patients with chronic kidney disease.
Abstract:
Cardiovascular disease is the leading cause of mortality amongst patients with chronic kidney disease (CKD). This is the first study using 3-dimensional echocardiography (3DE) to investigate associations between adverse changes of the left ventricle, and different stages of CKD. Participants were recruited from the Copenhagen CKD cohort study and the Herlev-Gentofte CKD cohort study. Patients were stratified according to GFR category (G1 + 2: eGFR ≥ 60 mL/min/1.73 m2, G3: eGFR = 30-59 mL/min/1.73 m2, and G4 + 5: eGFR ≤ 29 mL/min/1.73 m2), and according to albuminuria (A1: UACR < 30 mg/g, A2: 30-300 mg/g, A3: > 300 mg/g). Echocardiograms were analysed for left ventricular (LV) mass index (LVMi), LV ejection fraction (LVEF), and global strain measures. In adjusted analysis, eGFR groups were adjusted for confounders and albuminuria category, while albuminuria groups were adjusted for confounders and GFR category. The study population consisted of 662 outpatients with CKD and 169 controls. Mean age was 57 ± 13 years, and 61% were males. Mean LVEF and global longitudinal strain (GLS) were increasingly impaired across eGFR groups: LVEF = 60.1%, 58.4%, and 57.8% (p = 0.013), GLS = - 16.1%, - 14.8%, and - 14.6% (p < 0.0001) for G1 + 2, G3, and G4 + 5. LVMi and prevalence of LV hypertrophy increased with albuminuria severity: mean LVMi = 87.9 g/m2, 88.1 g/m2, and 92.1 g/m2 (p = 0.007) from A1-3. Adjusted analysis confirmed reduced LVEF in G3 compared with G1 + 2, and increased LVMi in A3 compared with A1. Increasingly impaired eGFR was associated with adverse changes in LV systolic function, while albuminuria was associated with adverse changes in LV mass assessed by 3DE. Their associations were independent of each other.
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