scholarly journals Left Atrial Reservoir Strain by Speckle Tracking Echocardiography: Association With Exercise Capacity in Chronic Kidney Disease

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Gary C.H. Gan ◽  
Aditya Bhat ◽  
Henry H.L. Chen ◽  
Kennith H. Gu ◽  
Fernando Fernandez ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Exercise Capacity ◽  
Left Atrial ◽  
Area Under The Curve ◽  
Left Ventricular ◽  
Exercise Stress ◽  
Ventricular Performance ◽  
Metabolic Equivalents ◽  
Echocardiographic Parameters

Background Left atrial (LA) function plays a pivotal role in modulating left ventricular performance. The aim of our study was to evaluate the relationship between resting LA function by strain analysis and exercise capacity in patients with chronic kidney disease (CKD) and evaluate its utility compared with exercise E/e'. Methods and Results Consecutive patients with stage 3 and 4 CKD without prior cardiac history were prospectively recruited from outpatient nephrology clinics and underwent clinical evaluation and resting and exercise stress echocardiography. Resting echocardiographic parameters including E/e' and phasic LA strain (LA reservoir [LASr], conduit, and contractile strain) were measured and compared with exercise E/e'. A total of 218 (63.9±11.7 years, 64% men) patients with CKD were recruited. Independent clinical parameters associated with exercise capacity were age, estimated glomerular filtration rate, body mass index, and sex ( P <0.01 for all), while independent resting echocardiographic parameters included E/e', LASr, and LA contractile strain ( P <0.01 for all). Among resting echocardiographic parameters, LASr demonstrated the strongest positive correlation to metabolic equivalents achieved (r=0.70; P <0.01). Receiver operating characteristic curves demonstrated that LASr (area under the curve, 0.83) had similar diagnostic performance as exercise E/e' (area under the curve, 0.79; P =0.20 on DeLong test). A model combining LASr and clinical metrics showed robust association with metabolic equivalents achieved in patients with CKD. Conclusions LASr, a marker of decreased LA compliance is an independent correlate of exercise capacity in patients with stage 3 and 4 CKD, with similar diagnostic value to exercise E/e'. Thus, LASr may serve as a resting biomarker of functional capacity in this population.

scholarly journals 1679 E/e predicts exercise capacity and adverse cardiovascular outcomes in patients with chronic kidney disease

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
G Gan ◽  
K Kadappu ◽  
A Bhat ◽  
F Fernandez ◽  
H Chen ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Exercise Capacity ◽  
Strong Predictor ◽  
Cardiovascular Death ◽  
Left Ventricular ◽  
Exercise Stress ◽  
Major Adverse Cardiovascular Events ◽  
Metabolic Equivalents

Abstract Funding Acknowledgements Nil OnBehalf NA Background Patients with chronic kidney disease(CKD) have reduced physical fitness that contributes to the disproportionately elevated risk of cardiovascular disease in this population. Our aim was to assess the association between E/e’ and exercise capacity in CKD patients and the prognostic role of E/e’. Methods Patients with Stage 3/4 CKD, without previous cardiac disease were prospectively recruited. Recruited patients underwent transthoracic echocardiogram and exercise stress echocardiogram with assessment of exercise E/e’. Patients were compared, one to one, to age, gender and risk factor matched controls and were followed annually for 5 years for cardiovascular death and major adverse cardiovascular events (MACE). Exercise capacity was assessed as metabolic equivalents (METs) with reduced exercise capacity defined as METS of ≤7. Raised exercise E/e’ was defined as exercise E/average e’ of &gt;13. Results 156 CKD patients (62.8 ± 10.6 yrs, male 62%) were compared to 156 matched controls. CKD patients had higher rates of anemia (p &lt; 0.01), larger left ventricular indexed mass (p &lt; 0.01), larger LAVI (p &lt; 0.01) and higher resting (p &lt; 0.01) and exercise E/e’ (p &lt; 0.01). Overall, CKD patients achieved lower METs (p &lt; 0.01) with exercise and a greater proportion of CKD patients had METs ≤7 (p &lt; 0.01). Receiver operating curves (Figure1) showed exercise E/e’ (AUC 0.89, CI 0.84-0.95, p &lt; 0.01) to be the strongest predictor of reduced exercise capacity in CKD patients. Exercise E/e’ of &gt;13 was also associated with higher rates of cardiovascular death and MACE amongst CKD patients. Conclusion Exercise E/e’ is a strong predictor of exercise capacity amongst CKD patients, who commonly have reduced exercise capacity presumably consequent to diastolic dysfunction. Raised exercise E/e’ in CKD patients is predictor of cardiovascular death and MACE. Abstract 1679 Figure.

scholarly journals P246 Exercise E/e refines diagnosis of diastolic impairment in patients with chronic kidney disease

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
G Gan ◽  
K Kadappu ◽  
A Bhat ◽  
F Fernandez ◽  
H Chen ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Exercise Capacity ◽  
Mitral Annulus ◽  
Left Ventricular ◽  
Exercise Stress ◽  
Total N ◽  
Metabolic Equivalents ◽  
Mitral Annulus Velocity ◽  
The Relationship

Abstract Background Diastolic dysfunction is common in chronic kidney disease (CKD) patients and is associated with reduced exercise capacity. The ratio of early diastolic mitral inflow velocity to early diastolic mitral annulus velocity (E/e’) correlates with invasively measured left ventricular pressures, both at rest and during exercise. The aim of our study was to evaluate the relationship of resting and exercise E/e’ to exercise capacity in patients with stage 3 and 4 CKD. Methods CKD patients were prospectively recruited. All patients were required to be in sinus rhythm, without previous cardiac disease and with normal LVEF. The E/e’ ratio was assessed at rest and patients were stratified into 3 groups based on conventional clinical classifications (normal: ≤8, indeterminate: 8-14, raised: &gt;14). Patients then underwent a symptom limited exercise stress echocardiogram whereby patients with resting E/e’ &lt;14 additionally had post exercise E/e’ measured. Exercise capacity was assessed as metabolic equivalents (METs). A raised exercise E/e’ was defined as exercise E/e’ of ≥13. Lastly, we grouped patients based on abnormalities of baseline and exercise E/e’ (resting E/e’&lt;14 & exercise E/e’&lt;13, resting E/e’&lt;14 & exercise E/e ≥13, resting E/e’ ≥14) and the relationship to METs achieved was evaluated. Results The cohort consisted of 156 CKD patients (62.8 ± 10.6 yrs, male 62%). 85% had hypertension and 39% had diabetes mellitus. 52/156 (34%) CKD patients had resting E/e’ of ≥14. Of the 104/156 (66%) CKD patients with normal/indeterminate resting E/e’, 66/104(63%) had normal exercise E/e’ &lt;13 whilst 38/104(37%) had exercise E/e’ ≥13. Patients with resting E/e" & raised exercise E/e’ ≥13 achieved significantly lower METs compared to CKD patients with resting E/e’ &lt;14 & exercise E/e’ &lt;13 (5.0 ± 2.2 vs 8.8 ± 2.5, p&lt; 0.01). Of note, METs achieved in this group were comparable to that achieved by CKD patients with raised resting E/e’ ≥ 14 (5.0 ± 2.2 METs vs 5.3 ± 2.6 METs, p = 0.55). Conclusion In CKD patients with normal/indeterminate resting E/e’, there is utility in performing exercise E/e’, which was increased in 37% of patients. Raised exercise E/e’ is associated with poorer exercise capacity and is a potential tool to refine diastolic abnormalities in patients with CKD. Group Total (n,%) METs Achieved Exercise Duration (minutes) Resting E/e’ ≤ 14 & Exercise E/e’ ≤ 13 66/156 (42%) 8.8 ± 2.5 8.4 ± 3.1 Resting E/e’ ≤ 14 & Exercise E/e’ ≥ 13 38/156 (24%) 5.0 ± 2.2 6.0 ± 3.1 Resting E/e’ ≥ 14 52/156 (34%) 5.3 ± 2.6 5.6 ± 2.2

Abstract 12992: LA Strain Predicts Exercise Capacity in Chronic Kidney Disease

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Gary Gan ◽  
Aditya Bhat ◽  
Henry H.L. Chen ◽  
Kennith Gu ◽  
Fernando Fernandez ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Exercise Capacity ◽  
Predictive Value ◽  
Strain Analysis ◽  
Left Ventricular ◽  
Exercise Stress ◽  
Clinical Predictors ◽  
Predictive Capacity ◽  
Ventricular Performance

Background: Left atrial (LA) function plays a pivotal role in modulating left ventricular performance particularly during exercise. The aim of our study was to evaluate the relationship between resting LA function by strain analysis as a determinant of exercise capacity in chronic kidney disease (CKD) patients, and evaluate its utility compared to exercise E/e’. Methods: Consecutive Stage 3 and 4 CKD patients without prior cardiac history were prospectively recruited from outpatient nephrology clinics and underwent clinical evaluation, resting and exercise stress echocardiography. Patients needed to be in sinus rhythm without significant valvular disease or ischaemia on stress testing. Resting echocardiographic parameters including E/e’ and phasic LA strain [LA reservoir (LASr), conduit (LAScd) and contractile (LASct) strain] were measured and compared to exercise E/e’. Results: 218 (63.9±11.7yrs, 64% men) CKD patients were recruited. Independent clinical predictors of exercise capacity were age, eGFR, body mass index and gender (p<0.01 for all) while independent resting echocardiographic predictors included E/e’, LASr and LASct (p<0.01 for all). Amongst independent resting echocardiographic predictors, LASr ( r =0.70,p<0.01) demonstrated the strongest correlation to METs achieved. Receiver operating characteristic curves (Figure 1) demonstrated that LASr (AUC 0.83,) had similar predictive value as exercise E/e’ (AUC 0.79; AUC difference of 0.05, p=0.20 on DeLong test). A model combining LASr and clinical metrics showed robust predictive capacity for METs achieved in CKD patients. Conclusions: LASr, a marker of decreased LA compliance is an independent predictor of exercise capacity in Stage 3 and 4 CKD patients, with similar predictive value to exercise E/e’. The use of LASr may serve as a resting biomarker of functional capacity in this population.

Abstract 14611: Indices of Myocardial Work is an Independent Predictor of Exercise Capacity

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Henry H Chen ◽  
Aditya Bhat ◽  
David Chandrakumar ◽  
Fernando Fernandez ◽  
Gary C Gan ◽  
...  
Keyword(s):  
Exercise Capacity ◽  
Left Atrial ◽  
Left Atrial Volume ◽  
Structural Heart Disease ◽  
Left Ventricular ◽  
Exercise Stress ◽  
Non Invasive ◽  
Work Index ◽  
Constructive Work ◽  
Lv Diastolic Dysfunction

Introduction: Exercise capacity has been shown to be an independent determinant of cardiovascular outcomes and prognosis. Conventional measures of left ventricular (LV) diastolic dysfunction, including E/e’ and left atrial (LA) metrics, have been shown to be independent predictors of exercise capacity however little is known about its relationship to myocardial energy utility and expenditure. Myocardial work (MW) is a novel non-invasive modality for assessment of myocardial efficiency and may serve to better define this relationship. Hypothesis: Greater wasted myocardial work is associated with reduced exercise capacity. Methods: Patients without prior cardiac disease referred to our echocardiography service for stress echocardiograms were prospectively recruited. These patients underwent comprehensive baseline transthoracic echocardiography (TTE) followed by exercise stress echocardiography. Only patients without structural heart disease on TTE and without ischaemia on stress testing were included. Myocardial work was assessed using EchoPac (v2.2, Chicago Illinois). Reduced exercise capacity was defined as METS achieved of ≤7. Results: 100 consecutive patients meeting inclusion criteria were analysed (45% male, age 56.0±15.7), of which 67% had diabetes and 44% had hypertension. The mean METS achieved was 8.5±3.7. Thirty-nine patients had a poor exercise capacity defined as METS achieved of ≤7. These patients were of older age, had greater indexed LV mass, higher E/e’, larger indexed left atrial volume, greater constructive work, greater wasted work, greater work index and lower work efficiency. On logistics regression, age (p<0.001), and myocardial wasted work (p=0.02) were independent predictors of poor exercise capacity after adjusting for the other clinical and echocardiographic variables. Conclusions: Reduced exercise capacity is independently associated with greater wasted work. Larger studies will be required to validate our findings.

scholarly journals Atherosclerotic vascular disease is more prevalent among black ESKD patients on long-term CAPD in South Africa

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
S. O. Oguntola ◽  
M. O. Hassan ◽  
R. Duarte ◽  
A. Vachiat ◽  
P. Manga ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Vascular Disease ◽  
Left Ventricular ◽  
Atherosclerotic Vascular Disease ◽  
Ckd Stage ◽  
Significant Difference ◽  
Echocardiographic Parameters ◽  
Relationship Of ◽  
The Relationship

Abstract Background Occurrence of cardiovascular disease (CVD) in the setting of chronic kidney disease (CKD) can be described as a “cruel alliance”, with CVD responsible for about half of all deaths among CKD patients. Chronic kidney disease patients are more likely to die from CVD than progress to end stage kidney disease (ESKD). Dyslipidaemia, a known traditional risk factor for CVD, is highly prevalent among CKD patients and with an even higher frequency among ESKD patients on dialytic therapies. Prolonged exposure of continuous ambulatory peritoneal dialysis (CAPD) patients to high glucose concentrations in CAPD fluid have been associated with increased risk of cardiovascular events. In this study, we investigated the relationship of atherosclerotic vascular disease (AsVD) to clinical and echocardiographic parameters among black South Africans with CKD (stage 3) and ESKD on CAPD and haemodialysis (HD). Methods This was a cross-sectional study of 40 adult (18–65 years) non-diabetic CKD patients (kidney disease outcome quality initiative [KDOQI] stage 3), 40 ESKD patients on CAPD, 40 ESKD patients on HD and 41 age and sex-matched healthy controls. An interviewer-administered questionnaire was used to obtain information on participants’ sociodemographic and cardiovascular risk factors. Anthropometric parameters were measured. Serum blood samples were analysed for creatinine, albumin and lipid profile; lipoprotein ratios, Framingham’s risk score and the 10-year risk of developing coronary heart disease (CHD) were calculated. Echocardiography was performed on all patients and carotid intima media thickness (CIMT) was measured in both right and left carotid arteries at 1 cm proximal to the carotid bulb. Spearman’s rank correlation and binary logistic regression were conducted to determine the relationship of AsVD to clinical and echocardiographic parameters. Results Atherosclerotic vascular disease was most prevalent among ESKD patients on CAPD (70%, n = 28/40). Chronic kidney disease and HD patients exhibited a similar prevalence (47.5%, n = 19/40), while the prevalence in controls was 17.1% (n = 7/41). Presence of AsVD was associated with significantly older age, higher waist hip ratio (WHR), left ventricular mass index (LVMI) and Framingham’s 10-year risk of developing CHD. Significant differences in clinical and echocardiographic parameters were observed when the study groups were compared. Age and LVH independently predicted AsVD. Conclusion Atherosclerotic vascular disease was more prevalent among CAPD patients compared to pre-dialysis CKD and HD patients. Among all lipoprotein ratios assessed, non-HDL-C showed the most consistent significant difference between the groups. Age (> 40 years) and presence of LVH were independent predictors of AsVD.

Vitamin D reduces left atrial volume in patients with left ventricular hypertrophy and chronic kidney disease

2012 ◽  
Vol 164 (6) ◽  
pp. 902-909.e2 ◽  
Author(s):  
Hector Tamez ◽  
Carmine Zoccali ◽  
David Packham ◽  
Julia Wenger ◽  
Ishir Bhan ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Vitamin D ◽  
Kidney Disease ◽  
Left Ventricular Hypertrophy ◽  
Left Atrial ◽  
Ventricular Hypertrophy ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Atrial Volume

scholarly journals P1709 Left atrial strain: a novel prognostic marker in patients with chronic kidney disease

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
G Gan ◽  
K Kadappu ◽  
A Bhat ◽  
F Fernandez ◽  
K Gu ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Left Atrial ◽  
Cardiovascular Events ◽  
Independent Predictor ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
End Point ◽  
Increased Risk

Abstract Funding Acknowledgements Nil Background and objectives Patients with chronic kidney disease (CKD) are at increased risk of adverse cardiovascular events that are underestimated by traditional risk stratification algorithms. We sought to determine clinical and echocardiographic predictors of adverse outcomes in CKD patients. Methods Stage 3 and 4 CKD patients without previous cardiac disease underwent a comprehensive transthoracic and stress echocardiogram, with left ventricular (LV) and left atrial (LA) strain analysis. Participants were followed for the primary end point of a composite of all-cause death and major adverse cardiovascular events (MACE). The secondary end point was a composite of cardiovascular death and MACE. Results 243 patients (male 63%; mean age 59.2 ± 14.4 years) were followed for a median of 3.9 ± 2.7 years. 69 patients met the primary endpoint and 58 the secondary end point. Age (p &lt; 0.01), history of diabetes mellitus (p &lt; 0.01), indexed LV mass(LVMI) (p &lt; 0.01), LV global longitudinal strain(GLS) (p &lt; 0.01), indexed LA volume(LAVI) (p &lt; 0.01), E/e’ ratio (p &lt; 0.01) and LA strain (LAs) (p &lt; 0.01) were independent predictors of death and MACE. On Cox proportional hazards regression analysis, LAs (p &lt; 0.01) was the only independent predictor for the primary end point in a model accounting for age, diabetes mellitus, LVMI, LVGLS, E/e’ and LAVI. LAs remained an independent predictor for the secondary end point. Conclusions LAs is an independent predictor of death and MACE in CKD patients, in whom the predominant cardiac abnormality is diastolic impairment. LAs is a prognostic biomarker, reflecting alterations in diastolic function in CKD. Abstract P1709 Figure. Kaplan Meier curve of LAs

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