The association between left ventricular global longitudinal strain, renal impairment and all-cause mortality

Krishnasamy, Rathika, Isbel, Nicole M., Hawley, Carmel M., Pascoe, Elaine M., Leano, Rodel, Haluska, Brian A. and Stanton, Tony (2014) The association between left ventricular global longitudinal strain, renal impairment and all-cause mortality. Nephrology Dialysis Transplantation, 29 6: 1218-1225. doi:10.1093/ndt/gfu004

Author Krishnasamy, Rathika
Isbel, Nicole M.
Hawley, Carmel M.
Pascoe, Elaine M.
Leano, Rodel
Haluska, Brian A.
Stanton, Tony
Title The association between left ventricular global longitudinal strain, renal impairment and all-cause mortality
Journal name Nephrology Dialysis Transplantation   Check publisher's open access policy
ISSN 0931-0509
Publication date 2014-01-01
Year available 2014
Sub-type Article (original research)
DOI 10.1093/ndt/gfu004
Open Access Status Not yet assessed
Volume 29
Issue 6
Start page 1218
End page 1225
Total pages 8
Place of publication Oxford, United Kingdom
Publisher Oxford University Press
Language eng
Subject 2727 Nephrology
2747 Transplantation
Abstract Left ventricular (LV) global longitudinal strain (GLS) may identify subclinical myocardial dysfunction in patients with aortic stenosis (AS). The aims of the present retrospective single centre study were to determine the independent prognostic value of LV GLS over LV ejection fraction (EF) and the role of LV GLS to further risk stratify severe AS patients before aortic valve replacement.
Formatted abstract
Background: Left ventricular (LV) systolic dysfunction is an important predictor of cardiovascular death. Global longitudinal strain (GLS) is a widely available echocardiographic technique proven to be more sensitive than conventional ejection fraction (EF) in detecting subtle changes in LV function. However, the prognostic value of GLS in patients with chronic kidney disease (CKD) is unknown.

Methods: We studied 447 patients from a single center who were stratified according to estimated glomerular filtration rate (eGFR). GLS was calculated using two-dimensional speckle tracking and EF was measured using Simpson's biplane. Cox proportional hazard model was used to identify independent predictors of survival and measures of discrimination and reclassification were used to assess the predictive value of GLS. Multivariable regression models were used to evaluate clinical and laboratory factors associated with GLS.

Results: The mean EF was 58 ± 11% and GLS was −16.6 ± 4.2%. eGFR correlated negatively with GLS (r = −0.14, P = 0.004). Factors that were independently associated with GLS include gender, previous myocardial infarction, eGFR and phosphate (R2 = 0.16, P < 0.001). Sixty-four patients died in a follow-up of 5.2 ± 1.4 years. GLS remained a significant predictor of all-cause mortality [hazard ratio (HR) 1.08, 95% confidence interval (CI) 1.01–1.15] following adjustment for age, diabetes mellitus, hypertension, eGFR and left ventricular mass index (LVMI). The strength of association between demographic data, eGFR, LVMI and mortality increased following addition of GLS [c-statistic 0.68 (95% CI 0.61–0.74) to 0.71 (95% CI 0.64–0.77), P = 0.04]. Addition of GLS also demonstrated a 21% net reclassification improvement in risk prediction for all-cause mortality over clinical factors.

Conclusions: GLS is an important predictor of all-cause mortality in CKD patients. Traditional and non-traditional risk factors such as phosphate are important determinants of GLS. Strain assessment in CKD patients may provide greater cardiovascular risk stratification.
Keyword All-cause mortality
Chronic kidney disease
Ejection fraction
Global longitudinal strain
Q-Index Code C1
Q-Index Status Confirmed Code
Grant ID 519823
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 24 times in Thomson Reuters Web of Science Article | Citations
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Created: Wed, 26 Feb 2014, 00:08:50 EST by Tony Stanton on behalf of Medicine - Princess Alexandra Hospital