Left Ventricular Global Longitudinal Strain Predicts Adverse Cardiovascular Outcomes in Patients With Comorbid Chronic Kidney Disease and Diabetes Mellitus

Abstract

Diabetes mellitus (DM) is a leading cause of chronic kidney disease (CKD) with patients with diabetic nephropathy having a disproportionately higher risk of cardiovascular (CV) disease compared to those with DM alone. Left ventricular (LV) global longitudinal strain (GLS) has been used to identify early LV dysfunction in DM. We sought to evaluate the prognostic value of LV-GLS in the diabetic population with concurrent CKD. Patients without prior cardiovascular disease with concurrent DM and CKD were prospectively recruited from outpatient Nephrology clinics across two tertiary institutions. All patients underwent clinical assessment and transthoracic echocardiogram with LV-GLS assessment at index recruitment. Patients were followed for up to five years for the primary outcome of CV death or development of major adverse cardiovascular outcomes (MACE). A total of 121 pts (67.17±10.98 yrs, 64% male) with DM and CKD were included. The mean eGFR was 36.2±13.4, with 68% having Stage 3 and 32% having Stage 4 disease. The primary outcome occurred in 33 (27%) patients over a mean follow-up period of 29.2±13.7 months. Log rank tests showed increased indexed LV mass (p<0.01), elevated E/e’ (p=0.04), larger indexed left atrial volume (p<0.01) and reduced LV-GLS (p<0.01) to be associated with the distribution to time to adverse outcomes. Nested multi-variable Cox regression analysis showed LV-GLS to be an independent predictor of CV death and MACE (p<0.01). In diabetic patients with CKD, LV-GLS was associated with cardiovascular death and MACE. This marker may be useful in risk stratification of this population.