말기콩팥병 환자에서 심초음파로 측정된 좌심실 global strain과 심혈관계 예후

Abstract

Backgrounds: Although left ventricular (LV) global strains measured by speckle-tracking echocardiography have been introduced as superior predictors for adverse cardiovascular (CV) events than ejection fraction (EF), there is limited data that it could be applied to patients with end-stage renal disease (ESRD). Method: A total of 136 patients starting maintenance dialysis therapy were analyzed (age 53.2±13.2 years, male 50.7%). Using speckle-tracking method, we measured the baseline global longitudinal strain (GLS) in apical 4-, 2- and 3-chamber views, the global circumferential strain (GCS) and the global radial strain (GRS) in a parasternal short-axis view. CV events were defined as CV death, coronary artery disease including myocardial infarction, unstable angina and coronary revascularization, and heart failure requiring hospitalization. The association between LV global strains and CV events were evaluated. Results: Fifty-three CV events occurred in 46 (33.8%) patients during 39±27 months of follow-up: 16 CV death, 13 coronary artery disease, 24 heart failure. In survival analysis adjusting clinical and laboratory variables, a higher GRS were independently associated with a lower CV event [hazard ratio (HR) 0.88, 95% confidence interval (CI) 0.77-1.00]. GLS and GCS, however, were not associated with CV events (HR 0.97, 95% CI 1.88-1.06 and HR 1.01, 95% CI 0.98-1.04, respectively). Conclusion: LV global strains measured by speckle-tracking echocardiographic imaging could be used to CV risk stratification in ESRD patients, but further large study is needed.