title: Prevalence, etiology, and clinical implications of reduced longitudinal systolic strain in renal transplant candidates.
abstract: OBJECTIVE
  Reduced global longitudinal systolic strain (GLS) is a common finding in end-stage renal disease (ESRD) patients with normal ejection fraction (EF), and GLS is a stronger predictor of mortality than EF. We sought to determine what factors may be responsible for the decreased strain in this population.
  
  
  RESULTS
  The study group was comprised of 139 renal transplant candidates with a normal EF who had echocardiography with assessment of GLS and basal longitudinal systolic strain (BLS). A GLS of less than -18 and a BLS less than -17 were defined as abnormal. Logistic regression was used to determine variables associated with abnormal GLS and BLS. Of the 139 patients, 49% had abnormal GLS and 70% had abnormal BLS. The univariate predictors of abnormal GLS (P<.05) were low-normal EF, increased interventricular septal thickness (IVS), diabetes, and dihydropyridine calcium channel blocker use. The univariate predictors of abnormal BLS (P<.05) were elevated systolic blood pressure, elevated diastolic blood pressure, elevated heart rate, decreased EF, increased IVS, increased left ventricular posterior wall thickness (LVPW), increased left ventricular mass index, regular dialysis, and clonidine use. On multivariate analysis, low-normal EF (P<.001), increased IVS (P=.024), and diabetes (P=.042) were independent predictors of abnormal GLS, while increased DBP (P=.018), increased LVPW (P=.001), and regular dialysis (P=.006) were independent predictors of abnormal BLS.
  
  
  CONCLUSIONS
  Clinical variables and co-findings beyond EF are associated with abnormal strain measurements and may partially explain the large incidence of abnormal strain in renal transplant candidates.
authors.affiliation: University Hospitals Case Medical Center, Cleveland, Ohio.
authors.forename: Isaac B
authors.identifier: http://orcid.org/0000-0002-4034-5682
authors.initials: IB
authors.lastname: Rhea
authors.affiliation: Department of Medicine, IU Health, Indianapolis, Indiana.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Morris
authors.affiliation: Krannert Institute of Cardiology, IU Health, Indianapolis, Indiana.
authors.forename: Stephen
authors.initials: S
authors.lastname: Sawada
authors.affiliation: Krannert Institute of Cardiology, IU Health, Indianapolis, Indiana.
authors.forename: Harvey
authors.initials: H
authors.lastname: Feigenbaum
mesh_terms: D004452:Echocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000601:surgery; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology*; D013599:Systole; D014481:United States / Q000453:epidemiology; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D016277:Ventricular Function, Left / Q000502:physiology*
keywords: end-stage renal disease; hemodialysis; myocardial strain