The prognostic value of left ventricular global peak systolic longitudinal strain in chronic peritoneal dialysis patients

Abstract

Background: Although left ventricular (LV) global systolic longitudinal strain (GLS) reliably and accurately assesses LV systolic function and is also a powerful prognostic predictor, the importance and prognostic value of GLS in end-stage renal disease patients receiving maintenance peritoneal dialysis (PD) remain unclear. This study sought to determine the prognostic value of GLS in chronic PD patients. Methods: This prospective study collected clinical and echocardiographic data from 106 stable PD patients (50.0 ± 13.9 years, 45% male) in a dialysis unit of a university hospital. These patients were enrolled from April 2010 to June 2010 and followed until August 2013 (follow-up duration 30.3 ± 14.3 months). The primary outcomes were the presence of major adverse events (MAEs), defined as all-cause mortality, and major adverse cardiovascular cerebral events (MACCEs), i.e. cardiovascular death, cardiac hospitalization, and stroke. Results: Twenty-nine patients (27%) reported a primary outcome. Patients with MAEs had worse LV systolic function (MAEs vs. no MAEs, −14.8 ± 2.8 vs. −17.1 ± 2.5%, p = 0.003). Using multivariate Cox regression analyses, being male, having a history of heart failure, diabetes mellitus, an increased pulse pressure (≥60 mm Hg), and GLS ≥ −15% were independent predictors of MAEs. The independent risk factors of MACCEs were a history of diabetes mellitus, an increased pulse pressure, and GLS ≥ −15%. After comparison of the overall log likelihood χ2 of the predictive power, GLS was found to add prognostic information to a model based on traditional risk factors. Conclusion: GLS ≥ −15% provided additional prognostic information that allowed for the early identification of high-risk PD patients.

Keywords

• Echocardiography
• End-stage renal disease
• Peritoneal dialysis
• Prognosis