Abstract 19383: Reduced Longitudinal and Circumferential Strains with Radial Compensation in End Stage Renal Disease Patients Despite Normal Ejection Fraction

Abstract

Background: Patients with end stage renal disease (ESRD) have high prevalence of heart failure despite normal left ventricular (LV) ejection fraction (EF) leading to adverse outcomes and higher mortality. Hence, we prospectively assessed LV strain patterns in ESRD patients with normal EF. Methods: We prospectively evaluated 100 ESRD patients with normal EF and wall motion and compared them to 22 age and gender matched controls. Complete demographic, clinical and echocardiographic data were collected. LV longitudinal, circumferential and radial strains were computed using speckle tracking echocardiography and corresponding end systolic wall stresses were calculated using Mirsky’s formulae. Results: The mean age was 54 years, 41% men, 53% had diabetes, mean EF was 65% and 15% had heart failure. The global longitudinal and mid LV circumferential strains were significantly lower in patients with ESRD with normal EF compared to the age and gender matched controls (-15.7+7.9% vs -20.4+4.1%, p=0.02 and 19.8+6.2% vs 25.2+3.8%, p=0.01 respectively). However, the radial strain was marginally higher compared to the controls (26.2+15.4% vs. 17.4+9.6%, p=0.07). Normalized for the corresponding wall stresses, only the circumferential strain was lower in ESRD patients and longitudinal and radial stresses were similar between the groups. Conclusions: 1) Global longitudinal and circumferential strains are reduced accompanied by an increase in radial strain in ESRD patients with normal EF. 2) This may only partly be explained by changes in wall stress and reflects incipient LV myocardial dysfunction. 3) Evaluation and targeting of abnormalities of LV wall stress and strain in this high risk population may help obviate heart failure and its deleterious consequences.