Left ventricular layer-specific strain measured by two-dimensional speckle tracking echocardiography in patients with chronic kidney disease
Objective To investigate the characteristics of left ventricular layer-specific strain in patients with chron-ic kidney disease(CKD).Methods Eighty-five patients with CKD in the Department of Nephrology from March 2020 to August 2021 were selected and divided into three groups according to the estimated glomerular filtration rate(eGFR):CKD stage 1-2(n=29),stage 3-4(n=20)and stage 5 group(n=36).Forty hypertensive patients without renal insufficiency were collected as hypertension(HT)group and 40 gender and age-matched healthy volun-teers were selected as the control group.Then,routine echocardiographic parameters,such as left ventricular diame-ter,left atrium diameter,wall thickness,left ventricular ejection fraction(LVEF),and myocardial strain parame-ters,such as global longitudinal strain(GLS),longitudinal strain in endocardium(SL-endo),longitudinal strain in average(SL-ave),longitudinal strain in epicardium(SL-epi),global circumferential strain(GCS),global circumfer-ential strain in endocardium(SC-endo),global circumferential strain in average(SC-ave),global circumferential strain in epicardium(SC-epi),and global radial strain(GRS)were analyzed.Results Compared with the control group,the left cardic structure and LVEF in stage 1-2 and stage 3-4 groups had no significant changes,left ven-tricular remodeling appeared and diastolic function declined in HT group and stage 5 group,LVEF decreased in stage 5 group(all P＜0.05).Only SL-endo decreased in HT group.All of SL-endo,SL-ave and SL-epi reduced in CKD group and were lowest in stage 5 group.Radial strain decreased only in stage 5 group(all P＜0.05).Correlation analysis showed that the global and layer-specific longitudinal strain were correlated with eGFR(r=0.541 to 0.559,all P＜0.05),LVEF was correlated with longitudinal and circumferential strain(r=0.406 to 0.424,all P＜0.05).Multiple linear regression analysis showed that longitudinal strain in different layers were independently correlated with different stages of CKD and the occurrence of secondary hypertension(β=-0.443 to-0.251,all P＜0.05).Circumferential strain in all layers were independently correlated with the appearance of secondary hypertension(β=-0.310 to-0.255,all P＜0.05).Conclusion The degree and range of the impairment of left ventricular strain in CKD patients are related to the stage of eGFR and secondary hypertension,which may affect the global systolic pump function by involving the circumferential strain.
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