The impact of the etiology of chronic kidney disease on left ventricular longitudinal function and filling pressures

Introduction: Altered left ventricular (LV) structure and function are classical hallmarks of cardiomyopathy in chronic kidney disease (CKD), with negative impact on cardiovascular prognosis. In these patients (pts), impairment of diastolic and longitudinal systolic LV function may occur early in evolution, even in the absence of LV hypertrophy or reduced LV ejection fraction (EF). The main determinants of incipient LV dysfunction in this clinical setting are incompletely defined. Therefore, we aimed to identify the determinants of decreased LV longitudinal function and increased LV filling pressures in pts with CKD. Methods: We prospectively enrolled 62 pts (65 ± 11 yrs, 42 men) with CKD and normal LV EF, in sinus rhythm. For a subgroup of 16 pts we enrolled 16 age- and gender-matched normal subjects. LV filling pressures were assessed using the E/e’ ratio. Global longitudinal LV strain (GLS) was assessed by 2D strain echocardiography. The staging of CKD was based on the glomerular filtration rate. Th e following biological markers were determined: albumin, hemoglobin (Hb), creatinine clea rance, mineral-bone metabolism biomarkers, intact parathyroid hormone. Results: Pts were divided into 2 groups according to the etiology of CKD: group 1- 45 pts with diabetic nephropathy or nephroangiosclerosis; group 2 – 17 pts with tubulointerstitial nephropathy or glomerulonephritis. CKD pts had higher E/e’ (p = 0.001) and worse values for GLS (p = 0.01) vs normal subjects. In pts, GLS was worse in men vs women (p = 0.02) and in group 1 vs group 2 (p = 0.04). E/e’ correlated with age (r = 0.33, p = 0.01), systolic PAP (r = 0.28, p = 0.02) and Hb (r = -0.29, p = 0.02), and was higher in group 1 vs group 2 (p = 0.001). There was a trend to correlation of GLS with age, LV mass and Hb. In multivariate analysis GLS correlated with gender (p = 0.009) and presence of group 1 etiology (p = 0.03), while E/e’ correlated with age (p = 0.04), Hb (p = 0.005) and presence of group 1 etiology (p = 0.004). Conclusions: In pts with CKD and normal LV ejection fraction the main correlates of GLS and E/e’ are age, gender, Hb and etiology of CKD. Older men with diabetic nephropathy or nephroangiosclerosis and anemia have more severe LV longitudinal dysfunction and higher LV filling pressures. This might be the rationale of a closer follow-up and a more aggressive treatment in these patients.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)