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Speckle tracking determination of mitral tissue annular displacement: comparison with strain and ejection fraction, and association with outcomes in haemodialysis patients

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Abstract

Abnormal Global longitudinal strain (GLS) and reduced left ventricular ejection fraction (LVEF) are established poor prognostic risk factors in haemodialysis patients. Tissue motion annular displacement of mitral valve annulus (TMAD), determined by speckle tracking echocardiography (STE), can be performed rapidly and is an indicator of systolic dysfunction, but has been less well explored. This study aims to compare TMAD with GLS and LVEF and its association with outcomes in haemodialysis patients. 198 haemodialysis patients (median age 64.2 years, 69 % men) had 2D echocardiography, with STE determined GLS and TMAD. Bland–Altman analysis and linear regression assessed relationship between GLS, LVEF and TMAD. Cox regression analysis investigated association of TMAD with mortality and cardiac events. TMAD had low inter- and intra-observer variability with small biases and narrow limits of agreement (LOA) (bias of −0.01 ± 1.32 (95 % LOA was −2.60 to 2.58) and −0.07 ± 1.27 (95 % LOA −2.55 to 2.41) respectively). There was a moderate negative correlation between GLS and LVEF (r = −0.383, p < 0.001) and a weak positive correlation between TMAD and LVEF (r = 0.248, p < 0.001). There was strong negative correlation of TMAD with GLS (r = −0.614, p < 0.001). In a multivariable Cox regression analysis, TMAD was not associated with mortality (HR 1.04, 95 % CI 0.91–1.19), cardiac death (HR 1.03, 95 % CI 0.80–1.32) or cardiac events (HR 0.91, 95 % CI 0.80–1.02). TMAD is a quick and reproducible alternative to GLS which may be very useful in cardiovascular risk assessment, but does not have the same prognostic value in HD patients as GLS.

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Acknowledgments

We would like to thank the patients of Salford Royal Hospital for their participation in this study. In addition, we would also like to thank the Salford Vascular Research team, in particular, Laura Johnstone and Dace Dimza who has helped with the logistics of carrying out this study. Also, we would like to thank Vaidehi Kataria, another researcher, who helped validate outcome data and echocardiography technician Janet Sewell, for carrying out some of the echocardiograms.

Funding

Dr. Diana Chiu, Dr. Darren Green, Dr. Nik Abidin and Professor Philip A Kalra are in receipt of a Kidney Research UK project Grant (RP35/2011) that has funded this study.

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Authors and Affiliations

  1. Vascular Research Group, Institute of Population Health, The University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK

    Diana Y. Y. Chiu, John Hughes, Smeeta Sinha, Philip A. Kalra & Darren Green

  2. Department of Renal Medicine, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, UK

    Diana Y. Y. Chiu, John Hughes, Smeeta Sinha, Philip A. Kalra & Darren Green

  3. Department of Cardiology, Salford Royal Hospital, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, UK

    Nik Abidin

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  1. Diana Y. Y. Chiu
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  2. Nik Abidin
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  3. John Hughes
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  4. Smeeta Sinha
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  5. Philip A. Kalra
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  6. Darren Green
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Correspondence to Darren Green.

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Chiu, D.Y.Y., Abidin, N., Hughes, J. et al. Speckle tracking determination of mitral tissue annular displacement: comparison with strain and ejection fraction, and association with outcomes in haemodialysis patients. Int J Cardiovasc Imaging 32, 1511–1518 (2016). https://doi.org/10.1007/s10554-016-0946-5

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  • DOI: https://doi.org/10.1007/s10554-016-0946-5

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