title: Subclinical markers of cardiovascular disease predict adverse outcomes in chronic kidney disease patients with normal left ventricular ejection fraction.
abstract: Emerging cardiovascular biomarkers, such as speckle tracking echocardiography (STE) and aortic pulse wave velocity (aPWV), have recently demonstrated the presence of subclinical left ventricular dysfunction and arterial stiffening in patients with chronic kidney disease (CKD) and no previous cardiovascular history. However, limited information exists on the prognostic impact of these biomarkers. We aimed to investigate whether STE and aPWV predict major adverse cardiac events (MACE) in this patient population. In this cohort study we prospectively analysed 106 CKD patients with no overt cardiovascular disease (CVD) and normal left ventricular ejection fraction. Cardiac deformation was measured using STE while aPWV was measured using arterial tonometry. The primary end-point was the composite of all-cause mortality, acute coronary syndrome, stable angina requiring revascularization (either using percutaneous coronary intervention or coronary artery bypass surgery), hospitalization for heart failure and stroke. Over a median follow up period of 49 months (interquartile range 11-63 months), 26 patients (24.5%) reached the primary endpoint. In a multivariable Cox hazards model, global longitudinal strain (GLS) (HR 1.12, 95% CI 1.02-1.29, p = 0.041) and aPWV (HR 1.31, 95% CI 1.05-1.41, p = 0.021) were significant, independent predictors of MACE. GLS and aPWV independently predict MACE in CKD patients with normal EF and no clinically overt CVD.
authors.affiliation: Imperial College London, National Heart and Lung Institute, Sydney Street, London, SW6 3NP, UK. s.sulemane11@imperial.ac.uk.
authors.forename: Samir
authors.identifier: http://orcid.org/0000-0002-3016-8459
authors.initials: S
authors.lastname: Sulemane
authors.affiliation: Imperial College London, National Heart and Lung Institute, Sydney Street, London, SW6 3NP, UK.|Imperial College Healthcare NHS, Hammersmith Hospital, Ducane road, London, W12 0HP, UK.
authors.forename: Vasileios F
authors.initials: VF
authors.lastname: Panoulas
authors.affiliation: Imperial College Healthcare NHS, Hammersmith Hospital, Ducane road, London, W12 0HP, UK.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Bratsas
authors.affiliation: Imperial College London, National Heart and Lung Institute, Sydney Street, London, SW6 3NP, UK.
authors.forename: Julia
authors.initials: J
authors.lastname: Grapsa
authors.affiliation: Imperial College Renal and Transplant Centre, Hammersmith Hospital, Ducane road, London, W12 0HP, UK.
authors.forename: Edwina A
authors.initials: EA
authors.lastname: Brown
authors.affiliation: Imperial College London, National Heart and Lung Institute, Sydney Street, London, SW6 3NP, UK.
authors.forename: Petros
authors.initials: P
authors.lastname: Nihoyannopoulos
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass; D018450:Disease Progression; D018619:Echocardiography, Doppler, Pulsed; D005260:Female; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D062645:Percutaneous Coronary Intervention; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D063177:Pulse Wave Analysis; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D015203:Reproducibility of Results; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D059289:Vascular Stiffness; D016277:Ventricular Function, Left
keywords: Aortic pulse wave velocity; Cardiovascular outcomes; Chronic kidney disease; Speckle tracking echocardiography