ABSTRACT
BACKGROUND: Chronic kidney disease (CKD) is associated with a higher incidence of cardiovascular death especially as the disease progresses and patients are on long-term dialysis treatment. Left ventricular (LV) dysfunction and cardiac deformation measured by speckle tracking echocardiography seem to play an important prognostic role in several different specific populations. OBJECTIVE: Τhe prognostic value of strain analysis measurements, including the novel diastolic parameters such as left atrial (LA) strain, in patients with end-stage renal disease on dialysis (stage 5 CKD). METHODS: 67 patients (mean age 62.3 ± 11.8, 65.7% men) with stage 5 CKD (45 on hemodialysis and 22 on peritoneal dialysis) were enrolled in the study protocol. The mean duration of dialysis was 102.48 ± 84.98 months. Mean follow-up lasted seven years. RESULTS: Most of the study population had normal or mildly impaired systolic function with a mean LV ejection fraction of 49.17% (± 10.41) while 70% of patients had impaired LV global longitudinal strain, mean 14.35% (± 4.49). Regarding LA strain parameters the mean LA reservoir, LA conduit, and LA contractile reserve were 24.11% (± 12.61), 10.56% (± 5.88), and 13.60% (± 9.15) respectively. Thus 50% of the population had impaired LA strain. Logistic regression analysis showed that of the various echocardiographic parameters LV ejection fraction, LV global longitudinal strain, and the conduit phase of LA strain were significantly associated with total prognosis (p = 0.009, p = 0.007, p = 0.05). The conduit element of LA strain was the strongest predictor among them, when adjusted for age (OR = 0.77 p = 0.04). CONCLUSIONS: Left ventricular diastolic dysfunction is an important prognostic factor in patients with advanced CKD on long-term dialysis, without known CAD. The novel echocardiographic parameters such as LA strain could add valuable information to the overall cardiac evaluation of this specific population.
