Frequency and risk factors of impaired left ventricular global longitudinal strain in patients with end-stage renal disease: a two-dimensional speckle-tracking echocardiographic study

Background The influence of hemodialysis (HD) on hydromechanics of the left ventricle has not been reported. This study evaluated the left ventricular summation of energy loss (EL-SUM), average energy loss (EL-AVE), and wall shear stress (WSS) before and after HD using vector flow mapping (VFM) in patients with end-stage renal disease (ESRD). Methods We prospectively recruited 40 patients receiving long-term HD and excluded those with structural cardiac disease. Echocardiography was performed before and within 24 hours after HD. Conventional echocardiographic parameters, summation, and average energy loss (EL-SUM, EL-AVE, EL-base, EL-mid and EL-apex), and WSS in each segment were compared. Results A total of 40 patients with uremia were recruited. After HD, left ventricular EL-AVE-total, and EL-SUM-total decreased significantly in the early diastolic [29.43 (18.76 to 46.28) vs. 17.70 (10.76 to 95.60) N/(m 2 ·s) and 12 (6 to 17) vs. 5 (3 to 11) e −2 J; P<0.001, respectively], mid-diastolic [17.07 (10.38 to 24.35) vs. 10.29 (5.86 to 16.30) N/(m 2 ·s) and 7 (3 to 10) vs. 4 (2 to 6) e −2 J; P<0.001, respectively], and early systolic [17.82 (12.79 to 24.77) vs. 14.90 (10.23 to 19.05) N/(m 2 ·s) P=0.011 and 8 (5 to 11) vs. 5 (4 to 8) e −2 J, P=0.002, respectively] phases. It was revealed that HD did not change EL-AVE-total and EL-SUM-total in the late diastolic and late systolic phases. The EL-AVE decreased after HD in the left ventricular (LV) basal [50.70 (24.19 to 77.92) vs. 26.00 (11.50 to 47.68) N/(m 2 ·s); P<0.001] and mid [15.52 (8.88 to 20.90) vs. 9.47 (6.41 to 14.21) N/(m 2 ·s); P=0.001] segments during the early diastolic phase; in the LV basal [18.64 (10.33 to 29.80) vs. 10.25 (6.98 to 19.43) N/(m 2 ·s); P<0.001), mid (15.70 (9.93 to 23.08) vs. 9.99 (6.03 to 16.25) N/(m 2 ·s); P<0.001), and apical [9.78 (4.06 to 15.77) vs. 4.52 (3.14 to 10.36) N/(m 2 ·s); P=0.001) segments during the mid-diastolic phase; in the LV mid [14.34 (8.34 to 23.88) vs. 9.36 (6.48 to 17.05) N/(m 2 ·s); P=0.013] and apex [11.25 (6.37 to 21.88) vs. 6.60 (5.33 to 12.17) N/(m 2 ·s); P=0.016] segments during the late diastolic phase; and in the apical [10.28 (6.05 to 17.01) vs. 7.59 (3.73 to 13.20) N/(m 2 ·s) P=0.025] seg...

Section: Introductionmentioning

confidence: 99%

Influence of a single hemodialysis on left ventricular energy loss and wall shear stress in patients with uremic cardiomyopathy assessed with vector flow mapping

Hong¹,

Zhang²,

Wang³

et al. 2022

“…Previous studies have also shown that MW is superior to GLS in predicting outcomes and detecting coronary heart disease and may find subclinical disorders that GLS cannot show (17,31,32). Furthermore, previous studies have considered patients with absolute GLS values <18% to have LV systolic insufficiency (33)(34)(35). In this regard, we performed further analysis: we divided SLE patients into ≥18% and <18% groups and found that the differences in GWE and GWW were statistically significant from the normal group regardless of whether GLS was impaired in SLE patients, and were more pronounced in those with <18%, which suggested that PSL parameters may be able to detect subclinical myocardial damage earlier than current methods (Table 6).…”

Section: Discussionmentioning

confidence: 99%

Quantitative assessment of left ventricular systolic function in patients with systemic lupus erythematosus: a non-invasive pressure-strain loop technique

Li¹,

Chen²,

Han³

et al. 2022

Self Cite

Background: Systemic lupus erythematosus (SLE) is associated with a variety of cardiovascular diseases, even in the early stage of disease development. The purpose of this study was to quantitatively evaluate left ventricular (LV) systolic function in patients with SLE using a novel non-invasive pressure-strain loop (PSL) technique.Methods: This prospective case-control study included 132 patients with SLE and 99 normal controls, all of whom underwent traditional transthoracic echocardiography. The LV myocardial work was evaluated with the PSL technique based on speckle tracking and brachial artery blood pressure. The differences among groups were compared, and the correlations between myocardial work, laboratory data, and disease activity were analyzed in the SLE group. Results: Compared with the normal group, SLE patients had significantly higher global wasted work {GWW; SLE: 109 [82-150] mmHg%; controls: 66 [45-109] mmHg%; P<0.001} and impaired global work efficiency [GWE; SLE: 95% (94-97%); controls: 97% (96-98%); P<0.001]. Global work index (GWI) and global constructive work (GCW) did not show significant differences (P>0.05). Further subdivision analysis found that the increase of GWW and the damage of GWE were more obvious in SLE patients with high disease activity or severe diastolic dysfunction. Multivariate analysis revealed that increased erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), anti-phospholipid antibodies, peak strain dispersion, and SLE Disease Activity Index (SLEDAI) were independently associated with increased GWW (β=0.189, 0.230, 0.444, 0.111, and 0.180, respectively; all P<0.05) and damaged GWE (β=−0.184, −0.130, −0.468, −0.149, and −0.191, respectively; all P<0.05). Conclusions: The non-invasive PSL can quantitatively evaluate the LV systolic function in SLE patients.This technique may provide a new method for monitoring cardiac function in chronic diseases.

“…Cancer treatment-related cardiac dysfunction is usually defined as a decline in the left ventricular ejection fraction (LVEF) ( 11 ). Speckle tracking echocardiography (STE) has been widely used to detect cardiac injury and to predict CAEs during cytotoxic drug chemotherapy ( 12 - 14 ). Nevertheless, both LVEF and STE are load dependent, which may lead to an underestimation of the true myocardial systolic function ( 15 ).…”

Section: Introductionmentioning

confidence: 99%

Evaluating the effect of PD-1 inhibitors on left ventricular function in lung cancer with noninvasive myocardial work

Li¹,

Wang²,

Kang³

et al. 2023

Background The treatment of advanced lung cancer has been revolutionized by immune checkpoint inhibitors (ICIs) in recent years, largely driven by programmed cell death-1 (PD-1) inhibitors. However, patients with lung cancer who are treated with PD-1 inhibitors are prone to immune-related adverse events (irAEs), especially cardiac adverse events. Noninvasive myocardial work is a novel technique used to assess left ventricular (LV) function, which can effectively predict myocardial damage. Here, noninvasive myocardial work was used to evaluate changes in LV systolic function during PD-1 inhibitor therapy and to assess ICIs-related cardiotoxicity. Methods From September 2020 to June 2021, 52 patients with advanced lung cancer in the Second Affiliated Hospital of Nanchang University were prospectively enrolled. In total, 52 patients underwent PD-1 inhibitor therapy. The cardiac markers, noninvasive LV myocardial work, and conventional echocardiographic parameters were measured at pretherapy (T0) and posttreatment after the first (T1), second (T2), third (T3), and fourth (T4) cycles. Following this, the trends of the above parameters were analyzed using analysis of variance with repeated measures and the Friedman nonparametric test. Furthermore, the relationships between disease characteristics (tumor type, treatment regimen, cardiovascular risk factors, cardiovascular drugs, and irAEs) and noninvasive LV myocardial work parameters were assessed. Results Throughout the follow-up, the cardiac markers and conventional echocardiographic parameters showed no significant changes. Based on the normal reference ranges, patients with PD-1 inhibitor therapy had increased values of LV global waste work (GWW) and decreased global work efficiency (GWE) that began at T2. Compared with T0, GWW increased from T1 to T4 (42%, 76%, 87%, and 87%, respectively), while global longitudinal strain (GLS), global work index (GWI), and global constructive work (GCW) decreased in varying degrees (P<0.001). Most of the disease characteristics had no effect on the LV myocardial work parameters; however, the numbers of irAEs were closely associated with GLS (P=0.034), GWW (P<0.001), and GWE (P<0.001). Patients with 2 or more irAEs had higher values of GWW and lower GLS and GWE. Conclusions Noninvasive myocardial work can accurately reflect myocardial function and energy utilization in patients with lung cancer who are undergoing PD-1 inhibitor treatment and may thus benefit the management of patients with ICIs-related cardiotoxicity.