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Published on: July 19, 2011
Resting strain analysis to identify myocardial ischemia in patients with advanced chronic kidney disease
Dimitrios Tsartsalis1, Yannis Dimitroglou1, Argyro Kalompatsou1
1First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece.
Insights
Resting left ventricular deformation analysis can predict myocardial ischemia in end-stage kidney disease patients undergoing stress echocardiography. This technique may help identify patients who could benefit from coronary artery screening.
Area of Science:
- Cardiology
- Nephrology
- Medical Imaging
Background:
- Chronic kidney disease (CKD) significantly increases cardiovascular mortality risk.
- Screening for coronary artery disease in CKD patients with mild symptoms is challenging.
Purpose of the Study:
- To assess the added value of resting deformation analysis in predicting myocardial ischemia during dobutamine stress echocardiography (DSE) in end-stage CKD patients.
Main Methods:
- Sixty-one end-stage CKD patients underwent resting echocardiography and DSE.
- Left ventricular (LV) ejection fraction (EF), LV global longitudinal strain (GLS), and left atrial (LA) strain were measured.
- Positive DSE results were defined as stress-induced LV wall motion abnormalities.
Main Results:
- The cohort showed preserved LV systolic function (mean EF 49.2%) but impaired LA strain in half the patients.
- DSE was positive for ischemia in 55.7% of patients.
- LV GLS and LA conduit strain were negatively associated with DSE results, while LV and LA dimensions correlated positively with ischemia.
Conclusions:
- Resting LV deformation parameters, particularly GLS, independently predict positive DSE results in end-stage CKD.
- LV deformation analysis may aid in identifying CKD patients who warrant further coronary artery screening.
Background:
Chronic kidney disease (CKD) is associated with higher incidence of cardiovascular death. Screening for coronary artery disease in asymptomatic or mildly symptomatic patients is challenging.
Objective:
The aim of this study was to investigate the incremental value of resting deformation analysis in predicting positive results for myocardial ischemia during stress transthoracic echocardiography in patients with end-stage CKD.
Methods:
Sixty-one patients (mean age: 62.3 ± 11.8, 65.7% men) with end-stage CKD were included in the study. Patients underwent a resting transthoracic echocardiogram and a dobutamine stress contrast echo (DSE) protocol. Positive results of DSE were defined as stress-induced left ventricular (LV) wall motion abnormalities.
Results:
The study cohort had normal or mildly impaired systolic function: mean LV ejection fraction (EF) was 49.2% (±10.4) and mean LV global longitudinal strain (GLS) was 14.4% (±4.5). Half of our population had impaired left atrial (LA) strain: mean LA reservoir, conduit, and contractile reserve were 24.1% (±12.6), 10.6% (±5.9), and 13.6% (±9.2), respectively. DSE was positive for ischemia in 55.7%. A significant negative association with DSE results was found for LV EF, LV GLS and the conduit phase of LA strain. Both LV and LA dimensions showed positive correlation with presence of ischemia in DSE. Multivariate logistic regression analysis showed that LV GLS was independently associated with DSE (p = 0.007), after controlling for covariates, with high diagnostic accuracy.
Conclusion:
Resting LV deformation could predict positive results during DSE, thus may be useful to better identify renal patients who might benefit from coronary artery screening.
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