Global Longitudinal Strain is a Superior Predictor of All-cause Mortality When Compared to Ejection Fraction in Patients with Mild to Moderate Chronic Kidney Disease

Abstract The left ventricular (LV) function remains preserved in the majority patients with chronic kidney disease (CKD). Despite this, Pulmonary edema can still occur in CKD patients with preserved ejection fraction during or after haemodialysis. The aim of our study was to determine whether assessment of Left ventricular global longitudinal strain (LV GLS) in CKD patients, could be used to detect sub clinical LV dysfunction and hence the propensity to develop pulmonary edema during or post hemodialysis. Our study cohort consisted of 105 CKD patients with normal Ejection fraction by transthoracic Echocardiography (TTE) and undergoing haemodialysis. There were 38 females and 67 males, ages ranging from 23 to 63yrs. They underwent detailed evaluation and assessment of risk factor profile, particularly the presence of hypertension and Diabetes. The Ejection fraction, presence of left ventricular hypertrophy (LVH), Left ventricular diastolic dysfunction (LVDD) and the LV GLS were assessed by TTE. Based on the findings, the male and female patients were divided into 3 groups. Group A with a GLS <−15, Group with a GLS between −15 and −18 and group C with GLS >−18. In group A, 81.1% of the males and 86.7% of the females developed pulmonary edema in contrast to 13% and 21.1% and 14.3% and 0% in groups B and C respectively. When LVDD was compared to the LV GLS it was found that in Group A, 80% of the males, and 88.2% of the females with LVDD developed pulmonary edema in contrast to 7% and 20% in group B and 0% and 0% in Group c respectively who had LVDD and developed pulmonary edema. In spite of having a normal LV diastolic function 100% of the males in group A developed pulmonary edema. Further, 92.8% of the males and 80% of the females in group B did not develop pulmonary edema despite having LVDD. So from our study, a cut of LV GLS value of −15 could predict pulmonary edema in CKD patients undergoing hemodialysis and although the majority were associated with LVDD, it could occur even in the absence of diastolic dysfunction. Further at LV GLS values >−15, the incidence of pulmonary edema was statistically significantly less despite having LVDD. Conclusion Left ventricular GLS appears to be a more reliable method than LVDD for predicting the occurrence of pulmonary edema during or post haemodialysis in CKD patients with normal LV Function, A LV GLS <15 would indicate the necessity for the implementation of appropriate precautions to prevent the occurrence of the same during dialysis. It can also be used in the long term follow up of patients.

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5014Left ventricular global longitudinal strain is associated with all-cause mortality in a large cohort of patients with chronic kidney disease

European Heart Journal ◽

10.1093/eurheartj/ehx493.5014 ◽

2017 ◽

Vol 38 (suppl_1) ◽

Author(s):

L.C.R. Hensen ◽

K. Goossens ◽

V. Delgado ◽

J.I. Rotmans ◽

J.W. Jukema ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Longitudinal Strain ◽

Global Longitudinal Strain ◽

Large Cohort ◽

All Cause Mortality

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Incremental value of global longitudinal strain in prediction of all-cause mortality in predialysis and dialysis chronic kidney disease patients

Wiener klinische Wochenschrift ◽

10.1007/s00508-016-0978-9 ◽

2016 ◽

Vol 128 (13-14) ◽

pp. 495-503 ◽

Cited By ~ 4

Author(s):

Ivana Valocikova ◽

Marianna Vachalcova ◽

Gabriel Valocik ◽

Marian Kurecko ◽

Mariana Dvoroznakova ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Longitudinal Strain ◽

Global Longitudinal Strain ◽

Incremental Value ◽

All Cause Mortality

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Left ventricular global longitudinal strain in chronic kidney disease patients with and without renal replacement therapy: A cross-sectional study

Indian Heart Journal ◽

10.1016/j.ihj.2020.11.074 ◽

2020 ◽

Vol 72 ◽

pp. S26

Author(s):

Ramesh Sankaran ◽

S. Ramalakshmi ◽

Manish Babbu Uppupetai Ganeshbabbu ◽

M. Jayakumar ◽

T.R. Muralidharan ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Renal Replacement Therapy ◽

Kidney Disease ◽

Replacement Therapy ◽

Longitudinal Strain ◽

Global Longitudinal Strain ◽

Cross Sectional Study ◽

Left Ventricular ◽

Sectional Study ◽

Cross Sectional

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SO057BETA-BLOCKERS ARE ASSOCIATED WITH REDUCED MORTALITY IN PATIENTS WITH HEART FAILURE WITH REDUCED EJECTION FRACTION AND ADVANCED CHRONIC KIDNEY DISEASE: COHORT STUDY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa139.so057 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Edouard L Fu ◽

Alicia Uijl ◽

Friedo W Dekker ◽

Lars H Lund ◽

Gianluigi Savarese ◽

...

Keyword(s):

Heart Failure ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Ejection Fraction ◽

Beta Blocker ◽

Beta Blockers ◽

Advanced Chronic Kidney Disease ◽

Reduced Ejection Fraction ◽

Patients With Heart Failure ◽

All Cause Mortality

Abstract Background and Aims Beta-blockers reduce mortality and morbidity in patients with heart failure (HF) with reduced ejection fraction (HFrEF). However, patients with advanced chronic kidney disease (CKD) were underrepresented in landmark trials. We evaluated if beta-blockers are associated with improved survival in patients with HFrEF and advanced CKD. Method We identified 3906 persons with an ejection fraction <40% and advanced CKD (eGFR <30 mL/min/1.73m2) enrolled in the Swedish Heart Failure Registry during 2001-2016. The associations between beta-blocker use, 5-year all-cause mortality, and the composite of time to cardiovascular (CV) mortality/first HF hospitalization were assessed by multivariable Cox regression. Analyses were adjusted for 36 variables, including demographics, laboratory measures, comorbidities, medication use, medical procedures, and socioeconomic status. To assess consistency, the same analyses were performed in a positive control cohort of 12,673 patients with moderate CKD (eGFR <60-30 mL/min/1.73m2). Results The majority (89%) of individuals with HFrEF and advanced CKD received treatment with beta-blockers. Median (IQR) age was 81 (74-86) years, 36% were women and median eGFR was 26 (20-28) mL/min/173m2. During 5 years of follow-up, 2086 (53.4%) individuals had a subsequent HF hospitalization, and 2954 (75.6%) individuals died, of which 2089 (70.1%) due to cardiovascular causes. Beta-blocker use was associated with a significant reduction in 5-year all-cause mortality [adjusted hazard ratio (HR) 0.86; 95% confidence interval (CI) 0.76-0.96)] and CV mortality/HF hospitalization (HR 0.87; 95% CI 0.77-0.98). The magnitude of the associations between beta-blocker use and outcomes was similar to that observed for HFrEF patients with mild/moderate CKD, with adjusted HRs for all-cause mortality and CV mortality/HF hospitalization of 0.85 (95% CI 0.78-0.91) and 0.88 (95% CI 0.82-0.96), respectively. Conclusion Despite lack of trial evidence, the use of beta-blockers in patients with HFrEF and advanced CKD was high in routine Swedish care, and was independently associated with reduced mortality to the same degree as HFrEF with moderate CKD.

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