Abstract 9615: Longitudinal Strain as a Novel Predictor of All-cause and Cardiovascular Mortality in Asymptomatic Hemodialysis Patients with Preserved Left Ventricular Ejection Fraction
Background End-stage renal disease is notorious for high mortality. For asymptomatic hemodialysis patients with preserved left ventricular ejection fraction (LVEF), little is known regarding the prognostic predictors. Two-dimensional speckle-tracking echocardiography with myocardial deformation analysis (2D strain) is reliable to assess LV function accurately and objectively. The prospective study was conducted to investigate prognostic value of LV global peak systolic longitudinal strain (GLS) in asymptomatic hemodialysis patients with preserved LVEF.
Methods Asymptomatic hemodialysis patients with LVEF≥50% underwent biochemistry blood tests, echocardiography, and 2D strain analysis. These patients were followed-up for more than 2.5 years.
Results Lower albumin levels, deteriorated GLS, and higher cardiac troponin T (cTnT) levels were detected in the mortality group compared to the controls. In Cox regression model, reduced GLS (GLS≥-15%, Hazard ratio (HR): 1.26, p=0.002) and increased cTnT level (cTnT >0.03 ng/ml, log cTnT HR: 14.43, p<0.001) were predictors to all-cause mortality (Figure A and B). Furthermore, hemodialysis patients with reduced GLS, but not those with increased cTnT level, had higher cardiovascular mortality rate (Figure C and D). Patients with cTnT >0.03 ng/ml and GLS ≥-15% had 7.8 times the risk of all-cause mortality and 6.1 times the risk of cardiovascular death compared to those with cTnT ≤0.03 ng/ml and GLS <-15%.
Conclusions Among asymptomatic hemodialysis patients with preserved LVEF, increased cTnT level and reduced GLS were associated with worse prognosis. Compared to cTnT, GLS is a stronger prognostic indicator in asymptomatic hemodialysis patients. The incremental prognostic value of GLS with elevated cTnT is potentially efficient and reliable.
- © 2012 by American Heart Association, Inc.