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A Comparative Analysis of Left Ventricular Myocardial Work in Patients with Diabetic and Non-Diabetic Kidney Disease
Minjie Wan1, Chunyan Yi2,3, Yan Wang1
1Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
Introduction:
Initiation of dialysis encompasses new cardiovascular challenges for patients with end-stage kidney disease (ESKD). The prognostic value of assessment of left ventricular (LV) myocardial function in peritoneal dialysis (PD) patients is still unclear. This study used global LV myocardial work (MW) indices to investigate the change of LV myocardial function undergoing PD within 1 year.
Methods:
A total of 179 patients with ESKD were enrolled in this prospective study. Among them, 48 patients were diagnosed with diabetic kidney disease (DKD), and 131 patients had non-diabetic kidney disease (NDKD). We evaluated LV myocardial function of patients with ESKD by two-dimensional speckle-tracking echocardiography (2D-STE) with strains and MW indices. Echocardiography and clinical data were evaluated at baseline and 1 year after PD.
Results:
Compared with the NDKD group, patients with DKD had lower global longitudinal strain (GLS) (14.43 ± 3.52 vs. 16.78 ± 4.78; p = 0.002), global work index (GWI) (1,546.29 ± 496.06 vs. 1,750.51 ± 416.97; p = 0.006), and global constructive work (GCW) (1,955.33 ± 483.86 vs. 2,129.65 ± 459.04; p = 0.028). After PD therapy, the NDKD group showed a significant reduction of GWI (1,616.78 ± 360.18 vs. 1,750.51 ± 416.97; p < 0.001), GCW (1,980.45 ± 385.82 vs. 2,129.65 ± 459.04; p = 0.006), and global wasted work (GWW) (158.00 [102.00, 219.00] vs. 185.00 [141.00, 250.00]; p < 0.001) and an increase of global work efficiency (GWE) (92.00 [89.00, 94.00] vs. 91.00 [88.00, 93.00]; p = 0.008). Compared with the NDKD group, the DKD group had a less decrease of GWW (-14.00 [-69.75, 85.00] vs. -36.00 [-97.00, 21.00]; p = 0.020) and a less increase of GWE (-1.00 [-4.00, 2.00] vs. 1.00 [-2.00, 4.00]; p = 0.006) after PD therapy. After multivariable adjustment, Δresidual GFR (β = -0.165; p = 0.034) and ΔDBP (β = -0.168; p = 0.028) were the significant independent determinants of ΔGWE. ΔDBP was the only significant independent determinant of ΔGWW (β = 0.343; p < 0.001).
Conclusion:
After 1 year of PD treatment, patients with NDKD showed improved LV myocardial function. However, the benefit for DKD patients was relatively limited, reflected in a smaller increase in GWE and a smaller reduction in GWW.
