Affiliation:
1. Nanjing First Hospital, Nanjing Medical University
2. Wuxi No.2 People’s Hospital, Jiangnan University Medical Center
Abstract
Abstract
Background
Little is known about the prognostic value of left atrial strain by four-dimensional speckle-tracking echocardiography in end-stage renal disease(ESRD) patients with preserved left ventricular ejection fraction(LVEF).
Methods
This prospective study collected clinical and echocardiographic data from 80 stable dialysis patients (mean age 57 ± 10 years; 62.5% men). All patients underwent the dedicated four-dimensional speckle-tracking echocardiography to measure LASr (peak longitudinal strain of reservoir function), LAScd (peak longitudinal strain of conduit function), LASct (peak longitudinal strain of contractile function), LASr_c (peak circumferential strain of reservoir function), LAScd_c (peak circumferential strain of conduit function) and LASct_c (peak circumferential strain of contractile function). These patients were enrolled from August 2021 to August 2023 and followed-up for 19months (interquartile-range 15 to 20months). The primary outcome was a composite of all-cause mortality or major adverse cardiovascular events (MACEs). The study patients were classified into event (developed mortality or MACEs) and event-free group according to the primary outcome. Multivariate Cox regression analysis was used to investigate risk factors for all-cause mortality or MACEs.
Results
The event group had lower LASr (16.4% vs. 21.2%, P = 0.0003), LASct (8.2% vs.11.2%, P = 0.01), LASr_c (25.2% vs.35.0%, P = 0.0004) and LASct_c (14.9%vs. 20.9%, P = 0.001) than the event-free group. Using the mean left atrial strain value as a cutoff, the less LASr (LASr < 20.2%), LASr_c (LASr_c < 32.9%), and LASct_c (LASct_c < 19.6%)group had a higher mortality or MACEs rate. Multivariate cox regression analyses revealed that LASr (HR = 0.81, 95% CI [0.17; 0.91], P = 0.0005, per 1% increase) and LASr_c (HR = 0.93, 95% CI [0.87; 0.98], p = 0.01, per 1% increase) were independent predictors of all-cause mortality or MACEs.
Conclusions
Less peak longitudinal and circumferential strains of reservoir function are predictive of poor prognosis among end-stage renal disease patients with preserved left ventricular ejection fraction.
Publisher
Research Square Platform LLC