title: Global longitudinal strain is an independent predictor of cardiovascular events in patients with maintenance hemodialysis: a prospective study using three-dimensional speckle tracking echocardiography.
abstract: The aim of this study was to investigate subclinical LV changes in patients with maintenance hemodialysis (MHD) using three-dimensional speckle-tracking echocardiography (3DSTE) and to explore its prognostic value. A total of 88 individuals were consecutively enrolled, including 66 subjects with MHD and 22 age- and sex-matched controls. Conventional and Real-time three-dimensional echocardiography was performed and analyzed. Left ventricular volume, strain and time parameters were calculated and compared. The MHD cohort was then followed to record cardiovascular events (CVE). Univariate and multivariate logistic regression analysis was used to identify independent predictors of CVE. Compared with the controls, MHD patients had significantly lower global longitudinal and radial strain (GLS and GRS), and LVEF (GLS: -17.0 ± 2.3 vs -18.8 ± 2.3 %; GRS: 37.0 ± 3.5 vs 39.4 ± 3.4 %; LVEF: 57.3 ± 4.2 vs 59.5 ± 3.5 %, p < 0.05 for all), as well as enlarged LV volume (EDV: 51.3 ± 14.2 vs 40.4 ± 7.3 ml/m(2); ESV: 22.0 ± 6.9 vs 16.3 ± 3.2 ml/m(2); SV: 29.2 ± 8.0 vs 24.0 ± 4.7 ml/m(2), p < 0.01 for all) and LV mass index (LVMi) (107.7 ± 28.6 vs 83.7 ± 20.6 g/m(2)). Time to minimum end-systolic volume and to peak longitudinal strain (T-msv and T-ls) were delayed in the MHD group (T-msv: 38.1 ± 5.2 vs 41.4 ± 6.4 %; T-ls: 38.1 ± 4.6 vs 42.1 ± 6.8 %, p < 0.05). Systolic dyssynchrony index (SDI) of the MHD group was significant larger than that of the controls (6.4 ± 1.5 vs 4.9 ± 1.8 %, p < 0.01). CVE occurred in 23 patients within a follow-up of 2 years. GLS and LVMi remained significant predictors of CVE [OR = 3.94, 95 % CI (1.33-11.66) for GLS and OR = 1.04, 95 % CI (1.01-1.07) for LVMi, p = 0.013 and 0.009, respectively]. Subclinical LV deformation and dysfunction exist in MHD patients with preserved LVEF. GLS and LVMi are two important predictors of CVE in MHD patients. Strain assessment in MHD patients may contribute to better vascular risk stratification.
authors.affiliation: Department of Echocardiography, Zhongshan Hospital of Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, 21 Room, M-floored,16 Building, No. 1609 Xietu Road, Shanghai, 200032, China.
authors.forename: Minmin
authors.identifier: http://orcid.org/0000-0002-2163-7188
authors.initials: M
authors.lastname: Sun
authors.affiliation: Department of Echocardiography, Zhongshan Hospital of Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, 21 Room, M-floored,16 Building, No. 1609 Xietu Road, Shanghai, 200032, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Kang
authors.affiliation: Department of Echocardiography, Zhongshan Hospital of Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, 21 Room, M-floored,16 Building, No. 1609 Xietu Road, Shanghai, 200032, China.
authors.forename: Leilei
authors.initials: L
authors.lastname: Cheng
authors.affiliation: Department of Echocardiography, Zhongshan Hospital of Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, 21 Room, M-floored,16 Building, No. 1609 Xietu Road, Shanghai, 200032, China.
authors.forename: Cuizhen
authors.initials: C
authors.lastname: Pan
authors.affiliation: Department of Nephrology, Zhongshan Hospital of Fudan University, Shanghai, China.
authors.forename: Xuesen
authors.initials: X
authors.lastname: Cao
authors.affiliation: Department of Echocardiography, Zhongshan Hospital of Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, 21 Room, M-floored,16 Building, No. 1609 Xietu Road, Shanghai, 200032, China.
authors.forename: Haohua
authors.initials: H
authors.lastname: Yao
authors.affiliation: Department of Echocardiography, Zhongshan Hospital of Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, 21 Room, M-floored,16 Building, No. 1609 Xietu Road, Shanghai, 200032, China.
authors.forename: Lili
authors.initials: L
authors.lastname: Dong
authors.affiliation: Department of Echocardiography, Zhongshan Hospital of Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, 21 Room, M-floored,16 Building, No. 1609 Xietu Road, Shanghai, 200032, China. shu.xianhong@zs-hospital.sh.cn.
authors.forename: Xianhong
authors.initials: X
authors.lastname: Shu
mesh_terms: D000328:Adult; D000368:Aged; D058070:Asymptomatic Diseases; D016022:Case-Control Studies; D019560:Echocardiography, Three-Dimensional; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009200:Myocardial Contraction; D015588:Observer Variation; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D013314:Stress, Mechanical; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D016277:Ventricular Function, Left
keywords: 3D echocardiography; Global longitudinal strain; LV function; Maintenance hemodialysis; Speckle tracking