Author + information
- Samir Sulemane,
- Vasileios F. Panoulas,
- Athanasios Bratsas,
- Andrew Frankel,
- Edwina Brown and
- Petros Nihoyannopoulos
Left ventricular ejection systolic function (LVEF) has been shown to be a good predictor of future cardiovascular outcomes in renal patients. Chronic kindey disease (CKD) patients with preserved LVEF also have excess cardiovascular mortality. To date, there is sparse, inconclusive evidence of presence of subclinical echocardiographic abnormalities in such patients. Our aim was to identify early markers of cardiovascular disease (CVD) in CKD patients using speckle tracking echocardiography.
We recruited 95 CKD patients (all stages) with no CVD and 33 healthy controls. All participants underwent conventional and 2D myocardial deformation echocardiography. Participants with LV systolic impairment or valvular disease were excluded. Segmental diastolic dysfunction (DD) was defined as SRe/SRa<1.1.
CKD patients were older than controls (53.5 ±20.2 vs. 36.7±12.0, p<0.001). There were 46.7% females in the CKD group vs. 54.5% in the control group (p=0.409). LVEF was similar between CKD and controls (63.5±6.1 vs. 63.2±5.3, p=0.802). In the CKD group the peak global longitudinal strain (GLS) was slightly reduced (trend) compared to controls (−19.1±3.0 vs. −20.2±2.4, p=0.067) whereas peak global circumferential strain (GCS) was similar in both groups (−24.4±4.7 vs. −25.4±4.1, p=0.283). When adjusting for age and gender there was no significant difference in GLS between CKD and controls (beta 0.635, p=0.316). Peak left ventricular twist (21.4±6.7 vs. 16.2±4.9, p<0.001) and twist rate (125.6±36.0 vs. 98.9±26.3, p<0.001) were significantly higher amongst CKD patients, even after age adjustment. CKD patients had more segments with DD compared to controls [7.0 (4.0 to 11.0) vs. 1.5 (0 to 4.5), p<0.001], an association that remains significant after adjustment for age. Worsening eGFR correlated with increased twist (−0.439, p<0.001), twist rate (−0.453, p<0.001) and higher number of segments with DD (rho=-0.304, p=0.005) but not with GLS or GCS.
In CKD patients with preserved LVEF, GLS and GCS appear intact whereas the number of segments with DD is increased. Peak twist and twist rate are increased and may represent a compensatory mechanism for worsening DD.
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Imaging: Cardiac Abnormalities in Non-Cardiac Disorders, Hand Held Echocardiography, Cardiac Masses
Abstract Category: 18. Imaging: Echo
Presentation Number: 1311-323
- 2013 American College of Cardiology Foundation