Key result
Patients with stages 1-3 chronic kidney disease exhibited significantly increased left ventricular energy loss during total diastole (7.38 vs 4.83 J/(m3s)) compared to healthy controls.
Why the study?
Patients with CKD develop abnormal intracardiac blood flow in early disease stages, but left ventricular energy loss using vector flow mapping and the impact of hypertension had not been evaluated.
Is left ventricular energy loss measured by vector flow mapping increased in patients with stages 1-3 CKD compared to controls, and does hypertension exacerbate this abnormality?
Cross-Sectional (n=89)
Single-blind
No
Is left ventricular energy loss measured by vector flow mapping increased in patients with stages 1-3 CKD compared to controls, and does hypertension exacerbate this abnormality?
Left ventricular energy loss measured by vector flow mapping is increased in early-stage CKD and further exacerbated by poorly controlled hypertension, serving as a potential marker for impaired intracardiac blood flow efficiency.
Should not yet change practice in early CKD; leaves open vector flow mapping as a research marker of flow inefficiency.
BACKGROUND: Patients with chronic kidney disease (CKD) experience abnormality of intracardiac blood flow status during early-stages of disease. Left ventricular energy loss (EL) derived from vector flow mapping (VFM) represents fluid energy lost as heat in left ventricle and had been used to detect intracardiac blood flow efficiency. We aimed to evaluate the left ventricular EL in stage 1-3 CKD patients, and explored whether hypertension, a main cardiovascular risk, deteriorate the abnormality of intracardiac blood flow status. METHODS: Transthoracic echocardiography was performed in 41 controls and 48 patients with stages 1-3 CKD. CKD patients consisted a subgroup with no hypertension, a subgroup with well-controlled hypertension and a subgroup with poorly controlled hypertension. The EL were calculated in the left ventricle using VFM analysis from the apical 3-chamber view. Furthermore, the correlation and stepwise multiple regression analysis were used to explore the potential independent predictors of left ventricular EL. RESULTS: Compared with controls, stage 1-3 CKD patients showed increased left ventricular EL during total diastole, late diastole, total systole, isovolumic contraction and ejection. CKD patients with poorly controlled hypertension had higher left ventricular EL compared to the other CKD subgroups. Additionally, the ratio of mitral early filling wave peak velocity and early mitral annular peak velocity on septal side, mitral early filling wave peak velocity, and left ventricular mass index were independent predictors of the diastolic EL; whereas systolic blood pressure and left ventricular mass index were independent predictors of the systolic EL. CONCLUSIONS: Left ventricular EL was a useful echocardiographic parameter to evaluate the impaired intracardiac blood flow efficiency in patients with stages 1-3 CKD. Hypertension was a crucial contributor for intracardiac blood flow abnormality. This study might provide valuable clinical data to discern cardiac dysfunction and reduce the cardiovascular risk in early-stage CKD.
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Chen et al. (2020) conducted a cross-sectional in Stages 1-3 chronic kidney disease (n=89). Stages 1-3 chronic kidney disease vs. Healthy controls was evaluated on Left ventricular energy loss during total diastole (EL-TD) (p=<0.001). Patients with stages 1-3 chronic kidney disease exhibited significantly increased left ventricular energy loss during total diastole (7.38 vs 4.83 J/(m3s)) compared to healthy controls.
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