Abstract

Chronic kidney disease (CKD) is a worldwide growing epidemic associated with an increased risk of cardiovascular morbidity and mortality. Left ventricular (LV) global longitudinal strain (GLS) is a measure of LV systolic function associated with prognosis in the general population. However, little is known about the association between LV GLS and survival in patients with CKD. The aim of the present study was to investigate the prognostic implications of LV GLS in predialysis and dialysis patients specifically. LV GLS was measured in a retrospective cohort of predialysis and dialysis patients (CKD stage 3b to 5) who underwent clinically indicated echocardiography between 2004 and 2015. Patients were divided into 4 groups according to quartiles of LV GLS: first quartile (LV GLS ≤10.6%, worst function), second quartile (LV GLS 10.7% to 15.1%), third quartile (LV GLS 15.2% to 17.8%), and fourth quartile (LV GLS ≥17.9%, best function). The primary end point was all-cause mortality. Of 304 patients (62 ± 14years, 66% male), 65% were in predialysis and 35% in dialysis. During a median follow-up of 29months (interquartile range 16 to 58months), 34% of patients underwent renal transplantation and 36% died. Patients with LV GLS ≤10.6% showed significantly worse prognosis compared with the other groups (log-rank test, p <0.001). LV GLS ≤10.6% was significantly associated with increased risk of all-cause mortality (hazard ratio 2.18, 95% CI 1.17 to 4.06, p= 0.014) after correcting for age, gender, albumin levels, atrial fibrillation, and renal transplantation. In conclusion, in predialysis and dialysis patients, severely impaired LV GLS is independently associated with an increased risk of mortality.

Highlights

  • Chronic kidney disease (CKD) is a worldwide growing epidemic associated with an increased risk of cardiovascular morbidity and mortality.1e4 Heart failure is frequent in patients with CKD.[2]

  • Pressure and volume overload and nonhemodynamic factors associated with CKD induce left ventricular (LV) hypertrophy, reduce capillary density, and increase myocardial fibrosis that lead to Left ventricular (LV) diastolic and systolic dysfunction.[5]

  • Nonhemodynamic factors associated with CKD such as inappropriate renin-angiotensin-aldosterone system activation, oxidative stress, inflammation, and stimulation of prohypertrophic and profibrogenic factors contribute to LV remodeling.[5,15]

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Summary

Introduction

Chronic kidney disease (CKD) is a worldwide growing epidemic associated with an increased risk of cardiovascular morbidity and mortality.1e4 Heart failure is frequent in patients with CKD.[2]. The aim of the present study was to investigate the prognostic implications of LV GLS in predialysis and dialysis patients

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