Early detection of subclinical left ventricular myocardial dysfunction in patients with chronic kidney disease

Aims To identify subclinical left ventricular (LV) myocardial dysfunction using speckle tracking echocardiography (STE) in patients with chronic kidney disease (CKD), preserved LV ejection fraction (LVEF), and no cardiovascular history or symptoms. Methods and results Cross-sectional comparisons of conventional and STE parameters were performed between controls and patients with different stages of CKD. CKD patients were followed up for major adverse cardiovascular events(MACEs). We recruited 106 CKD patients and 38 controls. Mean age was 54.4 +/- 15.1 and 36.9 +/- 11.5 years, respectively (P < 0.001), with 49.1 vs. 52.6% being female (P = 0.705). There were 29 (27.4%) patients with CKD stages 1/2, 38 (35.8%) with stage 3, and 39 (36.8%) with stages 4/5. Global longitudinal strain (GLS) was more impaired when moving from controls to CKD stages 4/5 (-20.67 +/- 3.06, -20.39 +/- 2.29, -18.33 +/- 3.81, -18.01 +/- 2.64, controls vs. CKD stages 1/2, vs. CKD stage 3, vs. CKD stages 4/5, respectively, P-adjusted = 0.016), whereas LV twist (16.2 +/- 4.8, 18.51 +/- 4.36, 19.91 +/- 5.35, 24.6 +/- 5.35, P-adjusted < 0.001) and LV twist rate (101.7 +/- 30.3, 110.4 +/- 30.1, 121 +/- 31.4, 154.8 +/- 36.7, P-adjusted < 0.001) increased. Risk factor-adjusted GLS (standardized beta beta = -0.245, P = 0.025), strain rate (SR) [global longitudinal strain rates (GLSRs); beta = -0.236, P = 0.019], and early diastolic longitudinal strain rate (GLSRe; beta = 0.247, P = 0.019) were significantly associated with estimated glomerular filtration rate (eGFR), whereas LV twist (beta = -0.432, P < 0.001), LV twist rate (beta = -0.433, P < 0.001), and number of segments with diastolic dysfunction (beta = -340, P < 0.001) were inversely and independently associated with eGFR. Impaired GLS (more than -16%) was observed in almost a quarter of CKD patients and associated with a reduced estimated MACE-free survival at 12-month follow-up (88.5 vs 93.7%, P-logrank = 0.038). Conclusion In CKD patients with no cardiovascular symptoms or history and preserved LVEF, STE can identify subclinical abnormalities of both systolic (decreased GLS and GLSR, increased LV twist, and twist rate) and diastolic (decreased GLSRe and increased number of segments with diastolic dysfunction) LV function.