Pressure-Strain Loop-Derived Myocardial Work in Hemodialysis versus Peritoneal Dialysis: A Cross-Sectional Echocardiographic Study.

Abstract

Objective Cardiovascular disease remains the leading cause of mortality in patients with end-stage renal disease (ESRD) patients. However, direct comparisons of myocardial performance between hemodialysis (HD) and peritoneal dialysis (PD) patients remain limited. This cross-sectional study aimed to assess and compare left ventricular (LV) myocardial work between ESRD patients undergoing HD and PD using noninvasive pressure-strain loop (PSL) analysis. Methods A total of 136 ESRD patients receiving maintenance dialysis, including 70 HD patients and 66 PD patients, together with 41 healthy controls, underwent echocardiographic PSL analysis. Myocardial work parameters, including global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE), were compared among groups. Results Compared with healthy controls, both dialysis groups showed significantly increased GWW and decreased GWE, indicating impaired myocardial work efficiency (all P <0.05). Despite comparable left ventricular ejection fraction and global longitudinal strain between the two dialysis groups, PD patients had significantly higher GCW than HD patients. Multivariable linear regression adjusting for potential confounders, including B-type natriuretic peptide and mean arterial pressure, showed that HD was independently associated with lower GCW. However, no significant differences were observed between HD and PD patients in GLS, GWI, or GWE. Given the modest effect size, borderline unadjusted statistical significance, and lack of correction for multiple comparisons, these findings should be considered hypothesis-generating and require confirmation in larger prospective studies. Conclusion Noninvasive PSL analysis may provide complementary information for characterizing myocardial work patterns in ESRD patients undergoing different dialysis modalities. PD was associated with higher GCW than HD, a difference not detected by conventional left ventricular ejection fraction or global longitudinal strain. Prospective multicenter studies are needed to confirm these associations and evaluate their prognostic significance.