Left Ventricular Global Longitudinal Strain in Patients with Chronic Kidney Disease with and Without Renal Replacement Therapy

Background: Cardiovascular disease is the leading cause of mortality among patients with chronic kidney disease (CKD). Hemodialysis treatment is associated with an increased risk of developing left ventricular (LV) dysfunction. LV global longitudinal strain (GLS) has emerged as a sensitive parameter in evaluating LV function in patients with CKD. We aimed to assess cardiac function using two-dimensional (2D) echocardiogram, 2D speckle-tracking echocardiogram (2DSTE), and traditional ejection fraction (EF) in patients undergoing hemodialysis. Methods: A cross-sectional study was conducted for 3 months in patients with CKD at a tertiary care center in Southern India. Patients were subjected to conventional 2DSTE and evaluated for LV ejection fraction (LVEF), GLS, pulmonary systolic blood pressure, and the degree of tricuspid regurgitation. Results: Among 100 patients with CKD, 54.3% underwent hemodialysis, and 26.7% on drug therapy had impaired LV GLS. The LVEF was normal in 61.4% of patients undergoing hemodialysis and 86.7% of patients on drug therapy. Proportion of patients undergoing hemodialysis were significantly high with moderate-to-severe pulmonary hypertension (21.4%), moderate-to-severe tricuspid regurgitation (21.4%), and mild-to-moderate EF (37.1%) compared to respective patients on drug therapy. Pulmonary hypertension and abnormal EF are significantly associated with lesser GLS in patients undergoing hemodialysis. Conclusions: This study indicated that patients undergoing hemodialysis are at higher risk for impaired LV GLS. The GLS by 2DSTE can act as an early diagnostic tool for this high-risk patient group. Thus, regular cardiac screening is required for early detection, and treatment in patients undergoing hemodialysis with risk of LV dysfunction.