Global longitudinal strain by feature tracking cardiovascular MRI predicts mortality in patients with end stage kidney disease

Rankin, A. J. et al. (2021) Global longitudinal strain by feature tracking cardiovascular MRI predicts mortality in patients with end stage kidney disease. Clinical Kidney Journal, 14(10), pp. 2187-2196. (doi: 10.1093/ckj/sfab020)

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Background: Patients with end-stage kidney disease (ESKD) are at increased risk premature death, with cardiovascular disease being the predominant mode of death. We hypothesized that left ventricular global longitudinal strain (LV-GLS) measured by feature tracking cardiovascular magnetic resonance imaging (CMR) would be associated with all-cause mortality in patients with ESKD. Methods: A pooled analysis of CMR studies in patients with ESKD acquired within a single centre between 2002 and 2016 was carried out. CMR parameters including left ventricular ejection fraction (LVEF), LV mass index (LVMI), left atrial emptying fraction (LAEF) and LV-GLS were measured. We tested independent associations of CMR parameters with survival using a multivariable Cox model. Results: Among 215 patients (mean age: 54 years, 62% male), mortality was 53% over 5.0 years median follow-up. The median LVEF was 64.7% (IQR 58.5, 70.0) and median LV-GLS was -15.3% (-17.24, -13.6). While 90% of patients had preserved LVEF (>50%), 58% of this group had abnormal LVGLS (>-16%). On multivariable Cox regression, age (HR: 1.04, 95%CI: 1.02-1.05), future-renal transplant (HR 0.29 95%CI: 0.17-0.47), LAEF (HR: 0.98, 95%CI: 0.96-1.00) and LV-GLS (HR: 1.08, 95%CI: 1.01-1.16) were independently associated with mortality. Conclusions: In this cohort of patients with ESKD, LV-GLS on feature tracking CMR and LAEF were associated with all-cause mortality, independent of baseline clinical variables and future renal transplantation. This effect was present even when >90% of the cohort had normal left ventricular ejection fraction (LVEF). Using LV-GLS, instead of LVEF, to diagnose cardiac dysfunction in patients with ESKD could result in a major advance in our understanding of cardiovascular disease in ESKD.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Patel, Dr Rajan and Rutherford, Dr Elaine and Mangion, Dr Kenneth and Woodward, Miss Rosemary and Lees, Jennifer and Roditi, Dr Giles and Mark, Professor Patrick and Gillis, Dr Keith and Rankin, Dr Alastair and Berry, Professor Colin
Authors: Rankin, A. J., Zhu, L., Mangion, K., Rutherford, E., Gillis, K. A., Lees, J. S., Woodward, R., Patel, R. K., Berry, C., Roditi, G., and Mark, P. B.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Clinical Kidney Journal
Publisher:Oxford University Press
ISSN (Online):2048-8513
Published Online:02 February 2021
Copyright Holders:Copyright © 2021 The Authors
First Published:First published in Clinical Kidney Journal 14(10): 2187-2196
Publisher Policy:Reproduced under a Creative Commons license

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
305025Non-invasively quantifying, understanding and reversing myocardial fibrosis in renal failureElaine RutherfordChief Scientist Office (CSO)PCL/18/03CAMS - Cardiovascular Science
300923Vitamin K in Transplanted Kidney Organ Recipients: Investigating vEssel Stiffness (ViKTORIES)Jennifer LeesKidney Research UK (KIDNEYRE)TF_013_20161125CAMS - Cardiovascular Science
308519Study of right ventricular volumes by feature tracking cardiac magnetic resonance imaging in patients with chronic kidney diseasePatrick MarkMedical Research Scotland (MEDRESSC)VAC-1514-2019CAMS - Cardiovascular Science
303944BHF Centre of ExcellenceRhian TouyzBritish Heart Foundation (BHF)RE/18/6/34217CAMS - Cardiovascular Science