title: Speckle tracking determination of mitral tissue annular displacement: comparison with strain and ejection fraction, and association with outcomes in haemodialysis patients.
abstract: Abnormal Global longitudinal strain (GLS) and reduced left ventricular ejection fraction (LVEF) are established poor prognostic risk factors in haemodialysis patients. Tissue motion annular displacement of mitral valve annulus (TMAD), determined by speckle tracking echocardiography (STE), can be performed rapidly and is an indicator of systolic dysfunction, but has been less well explored. This study aims to compare TMAD with GLS and LVEF and its association with outcomes in haemodialysis patients. 198 haemodialysis patients (median age 64.2 years, 69 % men) had 2D echocardiography, with STE determined GLS and TMAD. Bland-Altman analysis and linear regression assessed relationship between GLS, LVEF and TMAD. Cox regression analysis investigated association of TMAD with mortality and cardiac events. TMAD had low inter- and intra-observer variability with small biases and narrow limits of agreement (LOA) (bias of -0.01 ± 1.32 (95 % LOA was -2.60 to 2.58) and -0.07 ± 1.27 (95 % LOA -2.55 to 2.41) respectively). There was a moderate negative correlation between GLS and LVEF (r = -0.383, p < 0.001) and a weak positive correlation between TMAD and LVEF (r = 0.248, p < 0.001). There was strong negative correlation of TMAD with GLS (r = -0.614, p < 0.001). In a multivariable Cox regression analysis, TMAD was not associated with mortality (HR 1.04, 95 % CI 0.91-1.19), cardiac death (HR 1.03, 95 % CI 0.80-1.32) or cardiac events (HR 0.91, 95 % CI 0.80-1.02). TMAD is a quick and reproducible alternative to GLS which may be very useful in cardiovascular risk assessment, but does not have the same prognostic value in HD patients as GLS.
authors.affiliation: Vascular Research Group, Institute of Population Health, The University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK.|Department of Renal Medicine, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, UK.
authors.forename: Diana Y Y
authors.initials: DY
authors.lastname: Chiu
authors.affiliation: Department of Cardiology, Salford Royal Hospital, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, UK.
authors.forename: Nik
authors.initials: N
authors.lastname: Abidin
authors.affiliation: Vascular Research Group, Institute of Population Health, The University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK.|Department of Renal Medicine, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, UK.
authors.forename: John
authors.initials: J
authors.lastname: Hughes
authors.affiliation: Vascular Research Group, Institute of Population Health, The University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK.|Department of Renal Medicine, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, UK.
authors.forename: Smeeta
authors.initials: S
authors.lastname: Sinha
authors.affiliation: Vascular Research Group, Institute of Population Health, The University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK.|Department of Renal Medicine, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, UK.
authors.forename: Philip A
authors.initials: PA
authors.lastname: Kalra
authors.affiliation: Vascular Research Group, Institute of Population Health, The University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK. Darrengreen@doctors.org.uk.|Department of Renal Medicine, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, UK. Darrengreen@doctors.org.uk.
authors.forename: Darren
authors.initials: D
authors.lastname: Green
mesh_terms: D000368:Aged; D001696:Biomechanical Phenomena; D004452:Echocardiography / Q000379:methods*; D004739:England; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology; D015999:Multivariate Analysis; D015588:Observer Variation; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality; D015203:Reproducibility of Results; D012307:Risk Factors; D013314:Stress, Mechanical; D013318:Stroke Volume; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D016277:Ventricular Function, Left
keywords: Left ventricular systolic function; Mortality; Speckle tracking; Tissue motion annular displacement