Evaluation of global and regional left ventricular myocardial work by echocardiography in patients with chronic kidney disease

Abstract

Objective This study aimed to quantitatively evaluate the left ventricular myocardial work of patients with chronic kidney disease (CKD) by echocardiographic pressure–strain loop (PSL) analysis. Methods Ninety‐three patients with CKD and forty‐two age‐ and sex‐matched controls were included in the study. CKD patients were divided into group 1 (stages 2–4) and group 2 (stage 5). Left ventricular blood pressure was estimated noninvasively according to echocardiographic valvular events and brachial artery systolic pressure. Left ventricular myocardial work parameters were acquired by echocardiographic PSL analysis. Results The CKD groups had a significantly lower global work index (WI), global work efficiency (GWE), global constructive strain (GCW) and global longitudinal strain (GLS) and higher global waste work (GWW) than the control group. Segmental analysis showed that the myocardial WI, work efficiency (WE), and constructive work (CW) were lower in group 2 than the control group (P < .05), while the regional myocardial waste work (WW) was higher (P < .05). A Pearson correlation analysis revealed that GWE and GWW have good correlations with the LVEF and GLS. A multiple regression analysis showed that the systolic blood pressure (SBP), estimated glomerular filtration rate (eGFR), end‐diastolic volume (EDV), and GLS were associated with global work index (GWI) (b′ = 0.476, 0.252, −0.407, and −0.355, P < .05). Conclusions Left ventricular PSL analysis can be applied to assess global and regional myocardial work in CKD patients. This approach may serve as a noninvasive method for the detection of left ventricular systolic dysfunction at an early stage.

Assessment of subclinical left ventricle myocardial dysfunction using global myocardial work in type 2 diabetes mellitus patients with preserved left ventricle ejection fraction

“…The presented referral ranges of GWI, GCW, GWW and GWE were not affected by age. According to previous studies, MW has been reported in many diseases, including coronary heart disease [ 14 ], hypertension, cardiac resynchronization therapy (CRT), percutaneous coronary intervention (PCI) [ 18 ], aortic stenosis [ 19 ], transcatheter aortic valve replacement (TAVR) [ 20 ], dilated cardiomyopathy [ 21 ], hypertrophic cardiomyopathy [ 22 ], chronic kidney disease [ 23 ], and cardiac amyloidosis [ 24 ]. However, there has been little research about LV systolic function in T2DM patients with MW.…”

Myocardial Work: Methodology and Clinical Applications

“…Wasted work does not contribute to LV ejection, and healthy hearts produce an insignificant amount of wasted work [4]. MW has already proven to be more sensitive than EF in detecting LV dysfunction in cases of cardiomyopathy and normal EF [22] in patients with chronic kidney disease where subclinical dysfunction can be detected [23]. Similarly, in athletes with normal cardiac function, MW can detect myocardial changes after long-term intensive exercise [24].…”

Global longitudinal strain is superior to ejection fraction for detecting myocardial dysfunction in end-stage renal disease with hyperparathyroidism

“…This study showed that increased LVMI, low hemoglobin levels but high PTH are independent factors associated with GLS alterations. The overall average GLS was 13.55%, with LVEF > 50% in the patient population, which according to the literature, is related to poor prognosis[ 25 - 29 ]. In this case, it was suggested that in the population with ESRD, the determination of GLS by 2D-ECHO is highly recommended for the assessment of LVSF; being a more powerful tool than LVEF, which can identify systolic myocardial damage[ 3 , 18 , 19 ] during follow-up of patients[ 29 ].…”

“…In patients with ESRD, bone mineral disorder is correlated with adverse outcomes from cardiovascular causes[ 25 , 30 , 31 ]. Recently, the mineral disorders in the early stages of ESRD have been associated with myocardial remodeling, which is a crucial point for LVH development[ 31 - 33 ].…”