Abstract
BackgroundRecent studies hypothesized left ventricular (LV) twist as a potential biomarker for evaluation of sub clinical myocardial disease, however its relationship with aortic stiffness has yet to be investigated. Chronic kidney disease (CKD) has been identified as a risk factor for both myocardial and arterial disease. As such we sought to explore the relationship between aortic stiffness and LV twist in CKD patients without known cardiovascular disease (CVD).MethodsIn this prospective, observational study we enrolled 106 CKD patients (Stages 1 to 5) with normal LVEF as assessed by conventional echocardiography. Aortic stiffness was measured using aortic pulse wave velocity (aPWV). We defined increased aPWV as ≥10 m/s. LV Twist was measured using two-dimensional speckle tracking echocardiography.ResultsPatients with increased aPWV had higher LV twist (p = 0.002) but similar LVEF (p = 0.486). Aortic PWV correlated crudely with age (p < 0.001), the presence of diabetes (p < 0.001), hypertension (p < 0.001), eGFR (p < 0.001), LVMI (p = 0.01), e/e’ (p < 0.001) and LV twist (p = 0.003). In multivariable analyses after adjusting for age, gender, cardiovascular risk factors and hypertensive medication, aPWV was independently associated with LV twist (β = 0.163, p = 0.025).ConclusionsAortic stiffness independently associates with LV Twist in asymptomatic CKD patients. These findings suggest a close interaction between LV twist mechanics and arterial remodeling even before CVD becomes clinically relevant.
Highlights
Recent studies hypothesized left ventricular (LV) twist as a potential biomarker for evaluation of sub clinical myocardial disease, its relationship with aortic stiffness has yet to be investigated
LV twist has proven to be a Sulemane et al Cardiovascular Ultrasound (2016) 14:10 more sensitive marker of subtle myocardial dysfunction when compared with conventional echocardiographic methods, namely LV ejection fraction (LVEF) [11]
Twist mechanics can be accurately assessed using speckletracking echocardiography (STE), which has been validated against magnetic resonance imaging (MRI) and sonomicrometry [12]
Summary
Recent studies hypothesized left ventricular (LV) twist as a potential biomarker for evaluation of sub clinical myocardial disease, its relationship with aortic stiffness has yet to be investigated. Even though obstructive epicardial atherosclerotic disease is not an uncommon finding in patients with advanced CKD, early atherosclerotic changes in the macro- and microvasculature result in arterial stiffness that subsequently leads to structural myocardial disease [2, 3]. These pathophysiological features are manifested by a high risk of lethal arrhythmias, congestive heart. Panoulas et al identified Left Ventricular (LV) twist as a potential marker of sub clinical LV systolic dysfunction in CKD patients with normal ejection fraction, as measured by conventional 2D echocardiography [8]. Twist mechanics can be accurately assessed using speckletracking echocardiography (STE), which has been validated against magnetic resonance imaging (MRI) and sonomicrometry [12]
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