Association of Left Ventricular Longitudinal Strain with Mortality among Stable Hemodialysis Patients with Preserved Left Ventricular Ejection Fraction

Liu, Yen Wen; Su, Chi Ting; Sung, Junne Ming; Wang, Saprina P.H.; Su, Yu Ru; Yang, Chun; Tsai, Liang Miin; Chen, Jyh Hong; Tsai, Wei Chuan

doi:10.2215/cjn.10671012

Cited by 86 publications

(113 citation statements)

References 38 publications

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“…The more recent application of strain analysis has confirmed the prognostic value when the EF is preserved, supporting that the EF may not have been the optimal primary cardiac imaging-based outcome (30,31). In this trial there was a clear and consistent signal of both preservation of function directly measured by LV strain and inferred from reductions in LV mass and LV dilation that the cooling intervention was effective at protecting the heart.…”

Section: Discussionmentioning

confidence: 68%

“…Several studies in patients on HD showed an independent association of changes in LV mass with cardiovascular mortality (28,29). Recent studies determined that systolic strain and diastolic dysfunction predicted all-cause mortality or cardiovascular events in patients on HD with a normal EF (30,31). Both HD and non-HD population studies show that aortic distensibility independently predicts future cardiovascular events (22,32).…”

Section: Rationale For Study Outcomesmentioning

confidence: 99%

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Randomized Controlled Trial of Individualized Dialysate Cooling for Cardiac Protection in Hemodialysis Patients

Odudu

Eldehni

McCann

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Cardiovascular disease is the most common cause of death in patients on hemodialysis (HD). HD-associated cardiomyopathy is appreciated to be driven by exposure to recurrent and cumulative ischemic insults resulting from hemodynamic instability of conventionally performed intermittent HD treatment itself. Cooled dialysate reduces HD-induced recurrent ischemic injury, but whether this confers long-term protection of the heart in terms of cardiac structure and function is not known.Design, setting, participants, & measurements Between September 2009 and January 2013, 73 incident HD patients were randomly assigned to a dialysate temperature of 37°C (control) or individualized cooling at 0.5°C below body temperature (intervention) for 12 months. Cardiac structure, function, and aortic distensibility were assessed by cardiac magnetic resonance imaging. Mean between-group difference in delivered dialysate temperature was 1.2°C60.3°C. Treatment effects were determined by the interaction of treatment group with time in linear mixed models.Results There was no between-group difference in the primary outcome of left ventricular ejection fraction (1.5%; 95% confidence interval, -4.3% to 7.3%). However, left ventricular function assessed by peak systolic strain was preserved by the intervention (-3.3%; 95% confidence interval, -6.5% to -0.2%) as was diastolic function (measured as peak diastolic strain rate, 0.18 s 21 ; 95% confidence interval, 0.02 to 0.34 s 21 ). Reduction of left ventricular dilation was demonstrated by significant reduction in left ventricular end-diastolic volume (-23.8 ml; 95% confidence interval, -44.7 to -2.9 ml). The intervention was associated with reduced left ventricular mass (-15.6 g; 95% confidence interval, -29.4 to -1.9 g). Aortic distensibility was preserved in the intervention group (1.8 mmHg 21 310 23 ; 95% confidence interval, 0.1 to 3.6 mmHg 21 310 23 ). There were no intervention-related withdrawals or adverse events.

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Section: Discussionmentioning

confidence: 68%

Section: Rationale For Study Outcomesmentioning

confidence: 99%

Randomized Controlled Trial of Individualized Dialysate Cooling for Cardiac Protection in Hemodialysis Patients

Odudu

Eldehni

McCann

et al. 2015

Clinical Journal of the American Society of Nephrology

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“…57 Recently, Liu et al reported that global longitudinal strain is an independent predictor of all-cause mortality in patients with ESRD who have preserved left ventricular function. 58 Although radial, circumferential, and longitudinal fibers are predominantly in different layers of the myocardium, we observed reduced myocardial deformation in all these orientations when we compared our ESRD patient cohort to healthy persons. As heart muscle is incompressible, strain parameters are interrelated in three dimensions; thus, by the time the chamber contracts and shortens in systole (circumferential and longitudinal strain), the wall thickens (radial strain).…”

Section: Discussionmentioning

confidence: 72%

Speckle Tracking Echocardiography Detects Uremic Cardiomyopathy Early and Predicts Cardiovascular Mortality in ESRD

Kramann¹,

Erpenbeck²,

Schneider

et al. 2014

Journal of the American Society of Nephrology

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Cardiovascular mortality is high in ESRD, partly driven by sudden cardiac death and recurrent heart failure due to uremic cardiomyopathy. We investigated whether speckle-tracking echocardiography is superior to routine echocardiography in early detection of uremic cardiomyopathy in animal models and whether it predicts cardiovascular mortality in patients undergoing dialysis. Using speckle-tracking echocardiography in two rat models of uremic cardiomyopathy soon (4-6 weeks) after induction of kidney disease, we observed that global radial and circumferential strain parameters decreased significantly in both models compared with controls, whereas standard echocardiographic readouts, including fractional shortening and cardiac output, remained unchanged. Furthermore, strain parameters showed better correlations with histologic hallmarks of uremic cardiomyopathy. We then assessed echocardiographic and clinical characteristics in 171 dialysis patients. During the 2.5-year follow-up period, ejection fraction and various strain parameters were significant risk factors for cardiovascular mortality (primary end point) in a multivariate Cox model (ejection fraction hazard ratio [HR], 0.97 [95% confidence interval (95% CI), 0.95 to 0.99; P=0.012]; peak global longitudinal strain HR, 1.17 [95% CI, 1.07 to 1.28; P,0.001]; peak systolic and late diastolic longitudinal strain rates HRs, 4.7 [95% CI, 1.23 to 17.64; P=0.023] and 0.25 [95% CI, 0.08 to 0.79; P=0.02], respectively). Multivariate Cox regression analysis revealed circumferential early diastolic strain rate, among others, as an independent risk factor for all-cause mortality (secondary end point; HR, 0.43; 95% CI, 0.25 to 0.74; P=0.002). Together, these data support speckle tracking as a postprocessing echocardiographic technique to detect uremic cardiomyopathy and predict cardiovascular mortality in ESRD.

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“…Studies performed in adults with hypertension with speckle tracking technology have suggested that abnormalities in systolic performance in hypertensive LV hypertrophy can be identified, despite normal ejection fraction (18)(19)(20). Subclinical abnormalities of LV myocardial deformation in adults with early stage CKD have also been reported (21) as well as abnormal longitudinal systolic deformation in asymptomatic individuals with early CKD without clinical evidence of heart disease.…”

Section: Introductionmentioning

confidence: 99%

Advanced Parameters of Cardiac Mechanics in Children with CKD

Chinali

Matteucci²,

Franceschini

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Newer parameters of cardiac mechanics provide additional insights on cardiac dysfunction in adult patients with CKD. The aim of this study was to identify prevalence of subclinical abnormalities in cardiac function through the analysis of novel indices of cardiac mechanics in a large population of children with CKD.Design, setting, participants, & measurements Between 2009 and 2011, the prospective observational Cardiovascular Comorbidity in Children with CKD Study enrolled patients with CKD ages 6-17 years old with eGFR=10-45 ml/min per 1.73 m 2 in 14 European countries. Cardiac morphology and function were assessed through echocardiography. The analysis presented encompasses global radial, longitudinal, and circumferential strains as well as time to peak analysis. Data were compared with 61 healthy children with comparable age and sex.Results Data on 272 patients with CKD with complete echocardiographic assessment are reported (age =12.863.5 years old; 65% boys). Patients with CKD showed mildly higher office BP values and higher prevalence of left ventricular hypertrophy, but no differences were observed among groups in left ventricular ejection fraction. Strain analysis showed significantly lower global radial strain (29.6%613.3% versus 35.5%68.9%) and circumferential strain components (221.8%64.8% versus 228.2%65.0%; both P,0.05) in patients with CKD without significant differences observed in longitudinal strain (215.9%63.4% versus 216.2%63.7%). Lower values of global radial strain were associated with lower circumferential endocardial-to-epicardial gradient (r=0.51; P,0.01). This association remained significant after adjusting for BP, eGFR, and presence of left ventricular hypertrophy. Eventually, patients with CKD also showed higher delay in time to peak cardiac contraction (58628 versus 37618 milliseconds; P,0.05).Conclusions A significant proportion of children with CKD show impaired systolic mechanics. Impaired systolic function is characterized by lower radial strain, transmural circumferential gradient, and mild cardiac dyssynchrony. This study suggests that analysis of cardiac strain is feasible in a large multicenter study in children with CKD and provides additional information on cardiac pathophysiology of this high-risk population.

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Association of Left Ventricular Longitudinal Strain with Mortality among Stable Hemodialysis Patients with Preserved Left Ventricular Ejection Fraction

Cited by 86 publications

References 38 publications

Randomized Controlled Trial of Individualized Dialysate Cooling for Cardiac Protection in Hemodialysis Patients

Randomized Controlled Trial of Individualized Dialysate Cooling for Cardiac Protection in Hemodialysis Patients

Speckle Tracking Echocardiography Detects Uremic Cardiomyopathy Early and Predicts Cardiovascular Mortality in ESRD

Advanced Parameters of Cardiac Mechanics in Children with CKD

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