May 24, 2013Clinical Journal of the American Society of Nephrology91 citations

Association of Left Ventricular Longitudinal Strain with Mortality among Stable Hemodialysis Patients with Preserved Left Ventricular Ejection Fraction

YLYen-Wen LiuNational Cheng Kung University Hospital CSChi-Ting SuNational Taiwan University JSJunne‐Ming SungNational Cheng Kung University Hospital

PICO estructurado

Does less negative left ventricular global peak systolic longitudinal strain (GLS ≥ -15%) predict all-cause mortality in stable hemodialysis patients with preserved LVEF?

Población

88 stable hemodialysis patients with preserved left ventricular ejection fraction (LVEF ≥ 50%), mean age 67.0 ± 11.2 years, 35% men, from Taiwan. Key exclusions: age >80 years, LVEF <50%, heart failure with pulmonary edema in the past 6 months, acute coronary syndrome in the past 6 months, chronic atrial fibrillation, and moderate or severe valvular heart disease.

Intervención

Less negative left ventricular global peak systolic longitudinal strain (GLS ≥ -15%)

Comparador

More negative left ventricular global peak systolic longitudinal strain (GLS < -15%)

Resultado

All-cause mortalityhard clinical

In stable hemodialysis patients with preserved ejection fraction, less negative global longitudinal strain (≥ -15%) is a strong independent predictor of all-cause and cardiovascular mortality, highlighting its utility for early risk stratification.

Limitaciones

Small sample size with only 24 patients reaching the primary outcome, which might result in an unstable estimate in the multivariate Cox model

Resumen

BACKGROUND AND OBJECTIVES: Little is known about the optimal echocardiographic parameters for risk stratification in stable dialysis patients with preserved left ventricular ejection fraction (LVEF) (ejection fraction ≥ 50%). Left ventricular (LV) global peak systolic longitudinal strain (GLS) is the ratio of the maximal change in myocardial longitudinal length in systole to the original length and reliably and accurately assesses LV function. During systole, LV myocardium in the longitudinal direction shortens and GLS is represented by a negative value. The more negative value of GLS, the better the LV function is. This study hypothesized that subtle abnormalities of GLS are associated with an adverse prognosis. DESIGN, SETTING, PARTICIPANTS, 35% men) with preserved LVEF. These patients were enrolled from December 2008 to January 2009 and were followed-up for 25.6 ± 9.9 months. The primary outcome was all-cause mortality. Multivariate Cox regression analysis was used to investigate risk factors for mortality. RESULTS: The mortality group (n=24) had lower albumin levels, less negative GLS, and higher prevalence of coronary artery disease and diabetes mellitus than the survival group. Using a GLS cutoff value of -15%, the less negative GLS group (GLS ≥-15%) had a higher mortality rate. Cox regression analyses revealed that lower albumin level (hazard ratio, 0.16; 95% confidence interval, 0.05 to 0.53; P=0.003) and less negative GLS (hazard ratio, 3.57; 95% confidence interval, 1.41 to 9.04; P=0.01) were independent predictors of all-cause mortality. Furthermore, less negative GLS was associated with a higher cardiovascular death rate. CONCLUSIONS: Less negative GLS is predictive of poor prognosis among stable hemodialysis patients with preserved LVEF.

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