Subclinical abnormalities of left ventricular myocardial deformation in early-stage chronic kidney disease: the precursor of uremic cardiomyopathy?
BACKGROUND
Abnormal left ventricular (LV) deformation is an independent predictor of poor cardiovascular outcome in end-stage renal disease. Studies in early-stage chronic kidney disease (CKD) have not been performed despite the known graded inverse relationship between glomerular filtration rate and adverse cardiovascular events.


METHODS
Forty patients with CKD stage 2 or 3 and no history of cardiovascular disease or diabetes and 30 healthy controls underwent Doppler myocardial imaging for longitudinal deformation (strain/strain rate).


RESULTS
There were no differences in LV ejection fraction or systolic tissue Doppler velocities between patients with CKD and controls. In CKD, mean global strain (-15% +/- 4% vs -17% +/- 3%, P <.01) and mean global strain rate were reduced compared with controls (-0.88 +/- 0.16 vs -1.06 +/- 0.31, P <.05). Peak systolic strain was reduced in the basal lateral (-13.9% +/- 0.9% vs -17.9% +/- 1.02%, P <.01), basal septal (-17.1% +/- 0.8% vs -19.4% +/- 0.77%, P <.05), and mid-septal (-16.4% +/- 0.78% vs -18.9% +/- 0.88%, P <.05) walls with more basal postsystolic shortening (P <.01). Peak systolic strain rate was reduced in the basal lateral, mid-lateral, and mid-septal segments (P <.05).


CONCLUSIONS
Conventional measures of systolic function are preserved in early-stage CKD, but systolic deformation is abnormal, consistent with an adverse cardiovascular prognosis.
Edwards
Nicola C
NC
Department of Cardiology, University of Birmingham and University Hospital Birmingham, Birmingham, UK. N.C.Edwards@bham.ac.uk
Hirth
Asle
A
Ferro
Charles J
CJ
Townend
John N
JN
Steeds
Richard P
RP
D009202:Cardiomyopathies / Q000000981:diagnostic imaging* / Q000209:etiology; D004452:Echocardiography / Q000379:methods*; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D014511:Uremia / Q000000981:diagnostic imaging* / Q000209:etiology; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000000981:diagnostic imaging*