Left Ventricular Global Longitudinal Strain (GLS) Is a Superior Predictor of All-Cause and Cardiovascular Mortality When Compared to Ejection Fraction in Advanced Chronic Kidney Disease

Abstract

BackgroundEchocardiographic global longitudinal strain (GLS) is increasingly recognised as a more effective technique than conventional ejection fraction (EF) in detecting subtle changes in left ventricular (LV) function. This study investigated the prognostic value of GLS over EF in patients with advanced Chronic Kidney Disease (CKD).MethodsThe study included 183 patients (57% male, 63% on dialysis) with CKD stage 4, 5 and 5Dialysis (D). 112 (61%) of patients died in a follow up of 7.8 ± 4.4 years and 41% of deaths were due to cardiovascular (CV) disease. GLS was calculated using 2-dimensional speckle tracking and EF was measured using Simpson’s biplane method. Cox proportional hazard models were used to assess the association of measures of LV function and all- cause and CV mortality.ResultsThe mean GLS at baseline was -13.6 ± 4.3% and EF was 45 ± 11%. GLS was a significant predictor of all-cause [Hazard Ratio (HR) 1.09 95%; Confidence Interval (CI) 1.02–1.16; p = 0.01] and CV mortality (HR 1.16 95%; CI 1.04–1.30; p = 0.008) following adjustment for relevant clinical variables including LV mass index (LVMI) and EF. GLS also had greater predictive power for both all- cause and CV mortality compared to EF. Impaired GLS (>-16%) was associated with a 5.6-fold increased unadjusted risk of CV mortality in patients with preserved EF.ConclusionsIn this cohort of patients with advanced CKD, GLS is a more sensitive predictor of overall and CV mortality compared to EF. Studies of larger populations in CKD are required to confirm that GLS provides additive prognostic value in patients with preserved EF.

Periodontal-induced chronic inflammation triggers macrophage secretion of Ccl12 to inhibit fibroblast-mediated cardiac wound healing

“…LPS+MI exacerbated myocardial fiber rearrangement, resulting in decreased overall radial strain, systolic radial strain, and systolic longitudinal strain ( Figure 5, C-F). Impaired strain reflects increased myocardial wall stress, with concomitant decreased cardiac physiology and increased rupture (25). These results implicate Ccl12 as a possible mediator of adverse cardiac wound healing during chronic inflammation by interfering with multiple scar formation components.…”

Subclinical Compromise in Cardiac Strain Relates to Lower Cognitive Performances in Older Adults

“…Although LVEF is the most commonly used measure of cardiac function, it is load dependent, influenced by heart rate, and may not accurately reflect cardiac contractility as long as ventricular–vascular coupling is maintained22 or in the presence of hypertrophy 23, 24. GLS, however, has been shown to be a more sensitive measure of cardiac dysfunction 25. Because GLS measures the shortening of the longitudinal myocardial fibers located predominantly in the subendocardium,23 the wall layer most susceptible to ischemia,7 subclinical cardiac dysfunction can be detected earlier.…”

suPAR level is associated with myocardial impairment assessed with advanced echocardiography in patients with type 1 diabetes with normal ejection fraction and without known heart disease or end-stage renal disease

“…In prospective studies, GLS has been shown to be superior to ejection fraction (EF) in predicting mortality in patients with previous CVD or chronic kidney disease (28,29). In terms of diastolic function, e′/a′ ratio is known to be related to stiffness of the left ventricle, and to be impaired in insulin resistance (30) and diabetes (31).…”