Resting strain analysis to identify myocardial ischemia in patients with advanced chronic kidney disease

IF 1.3 4区医学 Q4 PHYSIOLOGY

Clinical Physiology and Functional Imaging Pub Date : 2024-02-05 DOI:10.1111/cpf.12871

Dimitrios Tsartsalis, Yannis Dimitroglou, Argyro Kalompatsou, Markos Koukos, Dimitrios Patsourakos, Elias Tolis, Spiros Tzoras, Dimitrios Petras, Costas Tsioufis, Constantina Aggeli

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Abstract

Background

Chronic kidney disease (CKD) is associated with higher incidence of cardiovascular death. Screening for coronary artery disease in asymptomatic or mildly symptomatic patients is challenging.

Objective

The aim of this study was to investigate the incremental value of resting deformation analysis in predicting positive results for myocardial ischemia during stress transthoracic echocardiography in patients with end-stage CKD.

Methods

Sixty-one patients (mean age: 62.3 ± 11.8, 65.7% men) with end-stage CKD were included in the study. Patients underwent a resting transthoracic echocardiogram and a dobutamine stress contrast echo (DSE) protocol. Positive results of DSE were defined as stress-induced left ventricular (LV) wall motion abnormalities.

Results

The study cohort had normal or mildly impaired systolic function: mean LV ejection fraction (EF) was 49.2% (±10.4) and mean LV global longitudinal strain (GLS) was 14.4% (±4.5). Half of our population had impaired left atrial (LA) strain: mean LA reservoir, conduit, and contractile reserve were 24.1% (±12.6), 10.6% (±5.9), and 13.6% (±9.2), respectively. DSE was positive for ischemia in 55.7%. A significant negative association with DSE results was found for LV EF, LV GLS and the conduit phase of LA strain. Both LV and LA dimensions showed positive correlation with presence of ischemia in DSE. Multivariate logistic regression analysis showed that LV GLS was independently associated with DSE (p = 0.007), after controlling for covariates, with high diagnostic accuracy.

Conclusion

Resting LV deformation could predict positive results during DSE, thus may be useful to better identify renal patients who might benefit from coronary artery screening.

查看原文本刊更多论文

通过静息应变分析识别晚期慢性肾病患者的心肌缺血。

背景：慢性肾脏病（CKD）与心血管死亡发生率较高有关。在无症状或症状轻微的患者中筛查冠状动脉疾病具有挑战性：本研究旨在探讨静息形变分析在预测终末期慢性肾脏病患者应力经胸超声心动图检查心肌缺血阳性结果方面的增量价值：研究共纳入 61 名终末期慢性肾脏病患者（平均年龄：62.3 ± 11.8，65.7% 为男性）。患者接受了静息经胸超声心动图检查和多巴酚丁胺应激对比回波（DSE）检查。DSE 阳性结果被定义为应激诱发的左心室壁运动异常：研究对象的收缩功能正常或轻度受损：平均左心室射血分数（EF）为49.2%（±10.4），平均左心室整体纵向应变（GLS）为14.4%（±4.5）。半数患者的左心房（LA）应变受损：平均 LA 储能、导管和收缩储备分别为 24.1%（±12.6）、10.6%（±5.9）和 13.6%（±9.2）。55.7%的缺血患者 DSE 呈阳性。发现左心室EF、左心室GLS和导管期LA应变与DSE结果呈明显负相关。左心室和 LA 的尺寸均与 DSE 中是否存在缺血呈正相关。多变量逻辑回归分析显示，在控制协变量后，左心室GLS与DSE独立相关（p = 0.007），诊断准确性高：结论：静息左心室变形可预测 DSE 的阳性结果，因此有助于更好地识别可能受益于冠状动脉筛查的肾病患者。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Physiology and Functional Imaging 医学-生理学

CiteScore

3.40

自引率

5.60%

发文量

审稿时长

6-12 weeks

期刊介绍： Clinical Physiology and Functional Imaging publishes reports on clinical and experimental research pertinent to human physiology in health and disease. The scope of the Journal is very broad, covering all aspects of the regulatory system in the cardiovascular, renal and pulmonary systems with special emphasis on methodological aspects. The focus for the journal is, however, work that has potential clinical relevance. The Journal also features review articles on recent front-line research within these fields of interest. Covered by the major abstracting services including Current Contents and Science Citation Index, Clinical Physiology and Functional Imaging plays an important role in providing effective and productive communication among clinical physiologists world-wide.