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The prognostic value of speckle tracking echocardiography in patients with end stage renal disease on dialysis

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Abstract

Background

Chronic kidney disease (CKD) is associated with a higher incidence of cardiovascular death especially as the disease progresses and patients are on long-term dialysis treatment. Left ventricular (LV) dysfunction and cardiac deformation measured by speckle tracking echocardiography seem to play an important prognostic role in several different specific populations.

Objective

Τhe prognostic value of strain analysis measurements, including the novel diastolic parameters such as left atrial (LA) strain, in patients with end-stage renal disease on dialysis (stage 5 CKD).

Methods

67 patients (mean age 62.3 ± 11.8, 65.7% men) with stage 5 CKD (45 on hemodialysis and 22 on peritoneal dialysis) were enrolled in the study protocol. The mean duration of dialysis was 102.48 ± 84.98 months. Mean follow-up lasted seven years.

Results

Most of the study population had normal or mildly impaired systolic function with a mean LV ejection fraction of 49.17% (± 10.41) while 70% of patients had impaired LV global longitudinal strain, mean 14.35% (± 4.49). Regarding LA strain parameters the mean LA reservoir, LA conduit, and LA contractile reserve were 24.11% (± 12.61), 10.56% (± 5.88), and 13.60% (± 9.15) respectively. Thus 50% of the population had impaired LA strain. Logistic regression analysis showed that of the various echocardiographic parameters LV ejection fraction, LV global longitudinal strain, and the conduit phase of LA strain were significantly associated with total prognosis (p = 0.009, p = 0.007, p = 0.05). The conduit element of LA strain was the strongest predictor among them, when adjusted for age (OR = 0.77 p = 0.04).

Conclusions

Left ventricular diastolic dysfunction is an important prognostic factor in patients with advanced CKD on long-term dialysis, without known CAD. The novel echocardiographic parameters such as LA strain could add valuable information to the overall cardiac evaluation of this specific population.

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    Authors and Affiliations

    1. First Department of Cardiology, ‘Hippokration’ Hospital, Medical School, University of Athens, Vasilissis Sofias 114, 11527, Athens, Greece

      Vicky Kakiouzi, Dimitrios Tsartsalis MD, PhD, FESC, Constantina Aggeli, Yannis Dimitroglou, Georgios Latsios, Eleftherios Tsiamis, Charalambos Vlachopoulos, Dimitrios Tousoulis & Costas Tsioufis

    2. Department of Emergency Medicine, ‘Hippokration’ Hospital, Athens, Greece

      Dimitrios Tsartsalis MD, PhD, FESC

    3. Department of Nephrology, ‘Hippokration’ Hospital, Athens, Greece

      Panagiota Giannou, Maria Karampela & Dimitrios Petras

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    1. Vicky Kakiouzi
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    Contributions

    CA, VK and DT designed the study. VK and DT performed the offline echocardiographic measurements and DT analyzed the data. VK, DT and CA drafted the manuscript. All authors interpreted the results, revised critically the original draft andd accepted the final version of the submitted manuscript.

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    Correspondence to Dimitrios Tsartsalis MD, PhD, FESC.

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    The study was approved by the institutional review board of Hippokration General Hospital.

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    Informed consent was obtained from all individual participants included in the study.

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    The authors confirm that patients provided informed consent for publication of the images in Figs. 1 and 2.

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    Vicky Kakiouzi and Dimitrios Tsartsalis made equal contributions to this manuscript and are jointly first authors.

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    Kakiouzi, V., Tsartsalis, D., Aggeli, C. et al. The prognostic value of speckle tracking echocardiography in patients with end stage renal disease on dialysis. Int J Cardiovasc Imaging 38, 2605–2614 (2022). https://doi.org/10.1007/s10554-022-02608-w

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