Evaluation of global and regional left ventricular myocardial work by echocardiography in patients with chronic kidney disease

OBJECTIVE: This study aimed to quantitatively evaluate the left ventricular myocardial work of patients with chronic kidney disease (CKD) by echocardiographic pressure-strain loop (PSL) analysis. METHODS: Ninety-three patients with CKD and forty-two age- and sex-matched controls were included in the study. CKD patients were divided into group 1 (stages 2-4) and group 2 (stage 5). Left ventricular blood pressure was estimated noninvasively according to echocardiographic valvular events and brachial artery systolic pressure. Left ventricular myocardial work parameters were acquired by echocardiographic PSL analysis. RESULTS: The CKD groups had a significantly lower global work index (WI), global work efficiency (GWE), global constructive strain (GCW) and global longitudinal strain (GLS) and higher global waste work (GWW) than the control group. Segmental analysis showed that the myocardial WI, work efficiency (WE), and constructive work (CW) were lower in group 2 than the control group (P < .05), while the regional myocardial waste work (WW) was higher (P < .05). A Pearson correlation analysis revealed that GWE and GWW have good correlations with the LVEF and GLS. A multiple regression analysis showed that the systolic blood pressure (SBP), estimated glomerular filtration rate (eGFR), end-diastolic volume (EDV), and GLS were associated with global work index (GWI) (b' = 0.476, 0.252, -0.407, and -0.355, P < .05). CONCLUSIONS: Left ventricular PSL analysis can be applied to assess global and regional myocardial work in CKD patients. This approach may serve as a noninvasive method for the detection of left ventricular systolic dysfunction at an early stage.