Investigation of Left Ventricular Layer-Specific Strain in Patients of Chronic Kidney Disease by 2-Dimensional Speckle Tracking Echocardiography

Abstract

Abstract OBJECTIVE To investigate the characteristics of left ventricular layer-specific strain in patients with chronic kidney disease (CKD). METHODS Eighty-five patients of chronic kidney disease in the Department of Nephrology of our hospital from March 2020 to August 2021 were selected and divided into three groups according to the estimated GFR: Group A (CKD stage 1–2), Group B (CKD stage 3–4), and Group C (CKD stage 5), 40 hypertensive patients without renal insufficiency were gathered as hypertension (HT) group and 40 gender and age-matched healthy volunteers were selected as the control group. Then, (i) Routine echocardiographic parameters: left ventricular diameter, left atrium diameter, wall thickness, LVEF. (ii) Myocardial strain: global longitudinal strain (GLS), longitudinal strain in endocardium (SL-endo), longitudinal strain in average (SL-ave), longitudinal strain in epicardium (SL-epi), global circumferential strain (GCS), global circumferential strain in endocardium (SC-endo), global circumferential strain in average (SC-ave), global circumferential strain in epicardium (SC-epi), and global radial strain (GRS) were analyzed. RESULTS (i) Compared with the control group, the structure of the left heart and LVEF in groups A and B had no significant changes, left ventricular remodeling appeared, and diastolic function declined in HT group and group C, LVEF decreased in group C (all P < 0.05). (ii) Only SL-endo decreased in the HT group. All of SL-endo, SL-ave, and SL-epi were reduced in the CKD group and were lowest in group C. Radial strain decreased only in group C (all P < 0.05). (iii) The global and layer-specific longitudinal strain were correlated with estimated glomerular filtration rate (eGFR) (r = 0.541–0.559, all P < 0.05), LVEF was correlated with longitudinal and circumferential strain (r = 0.406–0.424, all P < 0.05). Multiple linear regression analysis showed that longitudinal strain in different layers were independently correlated with different stages of CKD and the occurrence of secondary hypertension or not (β = −0.251 to −0.443, all P < 0.05). Circumferential strain in all layers were independently correlated with the appearance of secondary hypertension or not (β = −0.255 to −0.31, all P < 0.05). CONCLUSIONS The degree and range of the impairment of left ventricular strain in CKD patients are related to the stage of eGFR and secondary hypertension, which may affect the global systolic pump function by involving the circumferential strain.