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Left ventricular myocardial deformation in patients on maintenance haemodialysis
Hardeep Kaur Grewal1, Manish Jain2, Rakesh Bhat2
1Department of Cardiology, Medanta - The Medicity, Gurgaon, India.
Insights
Patients with chronic kidney disease on maintenance hemodialysis show impaired left ventricular function, specifically in longitudinal and circumferential mechanics, even with normal ejection fraction. Further research is needed to understand the implications of these changes.
Area of Science:
- Cardiology
- Nephrology
- Biomedical Engineering
Background:
- Chronic kidney disease (CKD) patients on maintenance hemodialysis (MHD) often develop left ventricular (LV) abnormalities.
- Speckle-tracking echocardiography is crucial for assessing LV myocardial deformation.
- Previous research highlighted reduced LV global longitudinal strain (GLS) in CKD patients, but other LV deformation components remain less understood.
Purpose of the Study:
- To comprehensively evaluate LV myocardial deformation in CKD patients undergoing MHD using speckle-tracking echocardiography.
- To compare LV deformation parameters between CKD patients on MHD and healthy controls.
- To elucidate the full spectrum of LV mechanical abnormalities in CKD patients on MHD.
Main Methods:
- A cohort of 90 CKD patients on MHD was compared with 45 age- and gender-matched healthy controls.
- Speckle-tracking echocardiography was employed to assess various components of LV myocardial deformation.
- Key parameters analyzed included LV global longitudinal strain (GLS), global circumferential strain, LV apical rotation, and LV twist.
Main Results:
- CKD patients exhibited a high prevalence of LV hypertrophy (77.8%) and diastolic dysfunction.
- Despite similar LV ejection fraction (LVEF) between groups, CKD patients showed significantly impaired LV GLS, global circumferential strain, LV apical rotation, and LV twist.
- No significant difference was observed in global radial strain between CKD patients and controls.
Conclusions:
- CKD patients on MHD demonstrate significantly impaired LV longitudinal and circumferential mechanics, even when LVEF is preserved.
- The prognostic significance of reduced LVGLS is established; further studies should investigate the prognostic value and potential reversibility of abnormal LV circumferential mechanics post-renal transplant.
Background:
Patients with chronic kidney disease (CKD) undergoing maintenance haemodialysis (MHD) develop several abnormalities of left ventricular (LV) structure and function. Speckle-tracking echocardiography permits compressive assessment of LV myocardial deformation. Previous studies involving CKD patients have shown a significant reduction in LV global longitudinal strain (GLS) with strong prognostic implications. However, the other components of LV deformation have not been fully elucidated.
Methods:
A total of 90 CKD patients undergoing MHD (mean age 41.3 ± 12.5 years, 80% men) were compared with 45 apparently healthy age- and gender-matched controls.
Results:
The CKD patients had a high prevalence (77.8% patients) of LV hypertrophy. They also had a significantly elevated ratio of early diastolic mitral inflow velocity to annular velocity (12.1 ± 4.6 vs. 7.1 ± 1.5, p < .001) indicating a high prevalence of LV diastolic dysfunction. LV ejection fraction (LVEF) was the same between the two groups, but the CKD patients had significantly impaired LVGLS (-17.8 ± 3.9 vs. -20.8 ± 2.6, p < .001), global circumferential strain (-14.0 ± 3.5 vs. -16.1 ± 3.4, p = .001), LV apical rotation (6.6 ± 4.7° vs. 8.8 ± 4.0°, p = .008) and LV twist (12.8 ± 6.1° vs. 15.0 ± 6.0°, p = .037). There was no difference in the global radial strain between the two groups.
Conclusions:
The present study shows that CKD patients on MHD have significantly impaired LV longitudinal and circumferential mechanics despite preserved LVEF. The prognostic implications of reduced LVGLS have already been demonstrated previously. Future studies are needed to assess the prognostic implications of abnormal LV circumferential mechanics as well as their reversibility following renal transplant.
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