title: Left Ventricular Global Longitudinal Strain (GLS) Is a Superior Predictor of All-Cause and Cardiovascular Mortality When Compared to Ejection Fraction in Advanced Chronic Kidney Disease.
abstract: BACKGROUND
  Echocardiographic global longitudinal strain (GLS) is increasingly recognised as a more effective technique than conventional ejection fraction (EF) in detecting subtle changes in left ventricular (LV) function. This study investigated the prognostic value of GLS over EF in patients with advanced Chronic Kidney Disease (CKD).
  
  
  METHODS
  The study included 183 patients (57% male, 63% on dialysis) with CKD stage 4, 5 and 5Dialysis (D). 112 (61%) of patients died in a follow up of 7.8 ± 4.4 years and 41% of deaths were due to cardiovascular (CV) disease. GLS was calculated using 2-dimensional speckle tracking and EF was measured using Simpson's biplane method. Cox proportional hazard models were used to assess the association of measures of LV function and all- cause and CV mortality.
  
  
  RESULTS
  The mean GLS at baseline was -13.6 ± 4.3% and EF was 45 ± 11%. GLS was a significant predictor of all-cause [Hazard Ratio (HR) 1.09 95%; Confidence Interval (CI) 1.02-1.16; p = 0.01] and CV mortality (HR 1.16 95%; CI 1.04-1.30; p = 0.008) following adjustment for relevant clinical variables including LV mass index (LVMI) and EF. GLS also had greater predictive power for both all- cause and CV mortality compared to EF. Impaired GLS (>-16%) was associated with a 5.6-fold increased unadjusted risk of CV mortality in patients with preserved EF.
  
  
  CONCLUSIONS
  In this cohort of patients with advanced CKD, GLS is a more sensitive predictor of overall and CV mortality compared to EF. Studies of larger populations in CKD are required to confirm that GLS provides additive prognostic value in patients with preserved EF.
authors.affiliation: Department of Renal Medicine, The University of Queensland at Princess Alexandra Hospital, Brisbane, Australia; School of Medicine, The University of Queensland, Brisbane Australia.
authors.forename: Rathika
authors.initials: R
authors.lastname: Krishnasamy
authors.affiliation: Department of Renal Medicine, The University of Queensland at Princess Alexandra Hospital, Brisbane, Australia; School of Medicine, The University of Queensland, Brisbane Australia.
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Isbel
authors.affiliation: Department of Renal Medicine, The University of Queensland at Princess Alexandra Hospital, Brisbane, Australia; School of Medicine, The University of Queensland, Brisbane Australia.
authors.forename: Carmel M
authors.initials: CM
authors.lastname: Hawley
authors.affiliation: School of Medicine, The University of Queensland, Brisbane Australia.
authors.forename: Elaine M
authors.initials: EM
authors.lastname: Pascoe
authors.affiliation: Cardiovascular Imaging Research Centre, The University of Queensland at Princess Alexandra Hospital, Brisbane, Australia.
authors.forename: Matthew
authors.initials: M
authors.lastname: Burrage
authors.affiliation: Cardiovascular Imaging Research Centre, The University of Queensland at Princess Alexandra Hospital, Brisbane, Australia.
authors.forename: Rodel
authors.initials: R
authors.lastname: Leano
authors.affiliation: Cardiovascular Imaging Research Centre, The University of Queensland at Princess Alexandra Hospital, Brisbane, Australia.
authors.forename: Brian A
authors.initials: BA
authors.lastname: Haluska
authors.affiliation: Menzies Research Institute, University of Tasmania, Hobart, Australia.
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Marwick
authors.affiliation: Cardiovascular Imaging Research Centre, The University of Queensland at Princess Alexandra Hospital, Brisbane, Australia.
authors.forename: Tony
authors.initials: T
authors.lastname: Stanton
mesh_terms: D002318:Cardiovascular Diseases / Q000401:mortality; D004452:Echocardiography; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology; D016277:Ventricular Function, Left / Q000502:physiology