title: Left ventricular global longitudinal strain is associated with cardiovascular risk factors and arterial stiffness in chronic kidney disease.
abstract: BACKGROUND
  Global longitudinal strain (GLS) has emerged as a superior method for detecting left ventricular (LV) systolic dysfunction compared to ejection fraction (EF) on the basis that it is less operator dependent and more reproducible. The 2-dimensional strain (2DS) method is easily measured and integrated into a standard echocardiogram. This study aimed to determine the relationship between GLS and traditional and chronic kidney disease (CKD)-related risk factors of cardiovascular disease (CVD) in patients with CKD.
  
  
  METHODS
  A cross sectional study of patients with moderate CKD stages 3 and 4 (n = 136). Clinical characteristics, anthropometric, biochemical data including markers of inflammation [C-reactive protein (CRP)], uremic toxins [indoxyl sulphate (IS), p-cresyl sulphate (PCS)], and arterial stiffness [pulse wave velocity (PWV)] were measured. Inducible ischemia was detected using exercise stress echocardiogram. GLS was determined from 3 standard apical views using 2-dimensional speckle tracking and EF was measured using Simpson's rule. Associations between GLS and traditional and CKD-related risk factors were explored using multivariate models.
  
  
  RESULTS
  The study population parameters included: age 59.4 ± 9.8 years, 58 % male, estimated glomerular filtration rate (eGFR) 44.4 ± 10.1 ml/min/1.73 m(2), GLS -18.3 ± 3.6 % and EF 65.8 % ± 7.8 %. This study demonstrated that GLS correlated with diabetes (r = 0.21, p = 0.01), history of heart failure (r = 0.20, p = 0.01), free IS (r = 0.24, p = 0.005) free PCS (r = 0.23, p = 0.007), body mass index (BMI) (r = 0.28, p < 0.001), and PWV (r = 0.24, p = 0.009). Following adjustment for demographic, baseline co-morbidities and laboratory parameters, GLS was independently associated with free IS, BMI and arterial stiffness (R(2) for model =  .30, p < 0.0001).
  
  
  CONCLUSIONS
  In the CKD cohort, LV systolic function assessed using GLS was associated with uremic toxins, obesity and arterial stiffness.
authors.affiliation: Department of Renal Medicine, The University of Queensland at Princess Alexandra Hospital, Brisbane, Australia. Rathika.Krishnasamy@health.qld.gov.au.|School of Medicine, The University of Queensland, Brisbane, Australia. Rathika.Krishnasamy@health.qld.gov.au.
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. Carmel.Hawley@health.qld.gov.au.|School of Medicine, The University of Queensland, Brisbane, Australia. Carmel.Hawley@health.qld.gov.au.|Translational Research Institute, Brisbane, Australia. Carmel.Hawley@health.qld.gov.au.
authors.forename: Carmel M
authors.initials: CM
authors.lastname: Hawley
authors.affiliation: Cardiovascular Imaging Research Center, The University of Queensland at Princess Alexandra Hospital, Brisbane, Australia. t.stanton@uq.edu.au.
authors.forename: Tony
authors.initials: T
authors.lastname: Stanton
authors.affiliation: School of Medicine, The University of Queensland, Brisbane, Australia. e.pascoe@uq.edu.au.|Translational Research Institute, Brisbane, Australia. e.pascoe@uq.edu.au.
authors.forename: Elaine M
authors.initials: EM
authors.lastname: Pascoe
authors.affiliation: Department of Renal Medicine, The University of Queensland at Princess Alexandra Hospital, Brisbane, Australia. Katrina.Campbell@health.qld.gov.au.|School of Medicine, The University of Queensland, Brisbane, Australia. Katrina.Campbell@health.qld.gov.au.|Translational Research Institute, Brisbane, Australia. Katrina.Campbell@health.qld.gov.au.
authors.forename: Katrina L
authors.initials: KL
authors.lastname: Campbell
authors.affiliation: Department of Renal Medicine, The University of Queensland at Princess Alexandra Hospital, Brisbane, Australia. Megan.Rossi@health.qld.gov.au.|School of Medicine, The University of Queensland, Brisbane, Australia. Megan.Rossi@health.qld.gov.au.|Translational Research Institute, Brisbane, Australia. Megan.Rossi@health.qld.gov.au.
authors.forename: Megan
authors.initials: M
authors.lastname: Rossi
authors.affiliation: Department of Renal Medicine, Cambridge University Hospital, Cambridge, England. willpetchey@doctors.org.uk.
authors.forename: William
authors.initials: W
authors.lastname: Petchey
authors.affiliation: Department of Renal Medicine, The University of Queensland at Princess Alexandra Hospital, Brisbane, Australia. Ken-Soon.Tan@health.qld.gov.au.|School of Medicine, The University of Queensland, Brisbane, Australia. Ken-Soon.Tan@health.qld.gov.au.|School of Medicine, Griffith University, Brisbane, Australia. Ken-Soon.Tan@health.qld.gov.au.
authors.forename: Ken-Soon
authors.initials: KS
authors.lastname: Tan
authors.affiliation: School of Human Movement Studies, The University of Queensland, Brisbane, Australia. k.weston@uq.edu.au.
authors.forename: Kassia S
authors.initials: KS
authors.lastname: Beetham
authors.affiliation: School of Human Movement Studies, The University of Queensland, Brisbane, Australia. jcoombes@uq.edu.au.
authors.forename: Jeff S
authors.initials: JS
authors.lastname: Coombes
authors.affiliation: Cardiovascular Imaging Research Center, The University of Queensland at Princess Alexandra Hospital, Brisbane, Australia. r.leano@uq.edu.au.
authors.forename: Rodel
authors.initials: R
authors.lastname: Leano
authors.affiliation: Cardiovascular Imaging Research Center, The University of Queensland at Princess Alexandra Hospital, Brisbane, Australia. b.haluska@uq.edu.au.
authors.forename: Brian A
authors.initials: BA
authors.lastname: Haluska
authors.affiliation: Department of Renal Medicine, The University of Queensland at Princess Alexandra Hospital, Brisbane, Australia. Nikky.Isbel@health.qld.gov.au.|School of Medicine, The University of Queensland, Brisbane, Australia. Nikky.Isbel@health.qld.gov.au.
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Isbel
mesh_terms: D000368:Aged; D015992:Body Mass Index; D003408:Cresols / Q000097:blood; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000503:physiopathology; D005080:Exercise Test; D005260:Female; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000503:physiopathology; D006801:Humans; D007200:Indican / Q000097:blood; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000503:physiopathology*; D012307:Risk Factors; D013463:Sulfuric Acid Esters / Q000097:blood; D014463:Ultrasonography; D059289:Vascular Stiffness; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology*
chemical_list: D003408:Cresols; D013463:Sulfuric Acid Esters; C408690:4-cresol sulfate; D007200:Indican