Estimated left ventricular pressure-myocardial strain loop as an index of cardiac work predicts all-cause mortality in patients receiving regular hemodialysis

Ke-Wei Chen; Wen-Tsong Hsieh; Chih-Yang Huang; Chih-Chia Huang; Hsin-Yueh Liang; Guei-Jane Wang

doi:10.1016/j.jdiacomp.2021.107890

Estimated left ventricular pressure-myocardial strain loop as an index of cardiac work predicts all-cause mortality in patients receiving regular hemodialysis

J Diabetes Complications. 2021 May;35(5):107890. doi: 10.1016/j.jdiacomp.2021.107890. Epub 2021 Feb 16.

Authors

Ke-Wei Chen¹, Wen-Tsong Hsieh², Chih-Yang Huang³, Chih-Chia Huang⁴, Hsin-Yueh Liang⁵, Guei-Jane Wang⁶

Affiliations

¹ Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan; Department of Cardiology, China Medical University Hospital, Taichung, Taiwan.
² Department of Pharmacology, School of Medicine, China Medical University, Taichung, Taiwan.
³ Department of Medical Research, China Medical University Hospital, Taichung, Taiwan; Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan; Cardiovascular and Mitochondrial Related Disease Research Center, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
⁴ Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.
⁵ Department of Cardiology, China Medical University Hospital, Taichung, Taiwan; Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung, Taiwan. Electronic address: liangsy2@gmail.com.
⁶ Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan; Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan; Department of Biotechnology, Asia University, Taichung, Taiwan. Electronic address: jennyw355@gmail.com.

PMID: 33642148
DOI: 10.1016/j.jdiacomp.2021.107890

Abstract

Background: A non-invasive method for left ventricular pressure-strain analysis has recently been introduced to provide information on cardiac work and detect subtler changes in cardiac function. This study aims to verify and construct a novel index that could accurately and independently predict the prognosis of patients with end-stage kidney disease (ESRD) receiving regular hemodialysis.

Methods: Patients with end-stage kidney disease (ESRD) receiving maintenance hemodialysis (4-h sessions, 3 times weekly for 3 months or more) and who underwent echocardiography between 2009 and 2014 in China Medical University Hospital, Taichung, Taiwan, were enrolled. Conventional (left ventricular ejection fraction, LVEF) and strain echocardiography parameters (global longitudinal strain, GLS; cardiac work index, CWI) in 102 eligible patients were analyzed and compared. CWI was calculated from estimated LV pressure-myocardial strain loop area.

Results: Results show that, while no significant differences were found between LVEF (0.57 ± 0.12 vs. 0.59 ± 0.09, P = 0.27) and GLS (-16.12 ± 6.57% vs. -18.44 ± 5.54%, P = 0.07), deceased patients had significantly lower CWI (1339 ± 683.05 mmHg% vs. 1883.38 ± 640.99 mmHg%, P = 0.0002) than surviving patients. The predictive values defined by area under the curve (AUC) of LVEF, GLS and CWI were 0.499, 0.619 and 0.724, respectively.

Conclusion: In conclusion, CWI is an accurately independent predictor of all-cause mortality in ESRD patients receiving regular hemodialysis and may superior to the current predictors such as LVEF and GLS.

Keywords: Cardiac function; End-stage renal disease; Hemodialysis; Mortality; Non-invasive; Strain analysis.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Humans
Kidney Failure, Chronic* / complications
Kidney Failure, Chronic* / therapy
Mortality*
Predictive Value of Tests
Prospective Studies
Renal Dialysis
Stroke Volume
Taiwan
Ventricular Dysfunction, Left* / diagnostic imaging
Ventricular Function, Left
Ventricular Pressure*