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      Left Ventricular Systolic Strain in Chronic Kidney Disease and Hemodialysis Patients


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          Background: The impact of chronic kidney disease (CKD) and hemodialysis on heart function is not fully understood. We aimed to investigate the influence of different stages of CKD and maintenance hemodialysis on heart function. Methods: One hundred fifty-three patients were categorized into 3 subgroups [56 without CKD as controls; 37 with moderate-advanced CKD, stages 3, 4 or 5, and 60 with end-stage renal disease (ESRD) undergoing maintenance hemodialysis]. Left ventricular (LV) function was assessed by conventional echocardiography and 2-dimensional speckle-tracking echocardiography with strain analysis (2D strain analysis). Results: There was no significant difference of gender, age and LV ejection fraction among groups. Compared with controls, global peak systolic longitudinal strain (GS<sub>l</sub>), circumferential strain and strain rate were decreased in the CKD group. Along with the decline of renal function, GS<sub>l</sub> deteriorated. Moreover, compared with moderate-advanced CKD patients, GS<sub>l</sub>, circumferential strain and strain rate were better in ESRD group receiving maintenance hemodialysis. Conclusions: Worsening renal function was associated with a reduction of systolic function, and could be quantified by 2D strain analysis. The hemodialysis patients have better LV systolic function than the moderate-advanced CKD patients.

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          Clinical and echocardiographic disease in patients starting end-stage renal disease therapy

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            Left ventricular strain and strain rate: characterization of the effect of load in human subjects.

            Left ventricular (LV) strain and strain rate have been proposed as novel indices of systolic function; however, there are limited data about the effect of acute changes on these parameters. Simultaneous Millar micromanometer LV pressure and echocardiographic assessment were performed on 18 patients. Loading was altered sequentially by the administration of glyceryl trinitrate (GTN) and saline fluid loading. Echocardiographic speckle tracking imaging was used to quantify the peak systolic strain (S) and peak systolic strain rate (SR S) and dp/dt max was recorded from the micromanometer data. GTN administration decreased preload (LV end diastolic pressure [LVEDP]: 15.7 vs. 8.4 mmHg, P < 0.001) and afterload (end systolic wall stress: 74 vs. 43 x 10(3)dyn/cm(2), P < 0.001). Administration of fluid increased preload (LVEDP: 11.3 vs. 18.1 mmHg, P < 0.001) and increased wall stress (53 vs. 62 x 10(3)dyn/cm(2), P < 0.003). Administration of GTN resulted in increased circumferential SR S (-1.2 vs. -1.7s(-1), P < 0.01) and longitudinal SR S (-0.9 vs. -1.0 s(-1), P < 0.001). The administration of fluid resulted in decreased circumferential SR S (-1.5 vs. -1.3s(-1), P < 0.01) and longitudinal SR S (-1.0 vs. -0.9s(-1), P < 0.01). As preload and afterload increased, decrease in circumferential SR S (r = 0.63, P < 0.001; r = 0.56, P<0.001) and longitudinal SR S were observed (r = 0.42, P < 0.003; r = 0.49 P < 0.001). Circumferential and longitudinal peak strain and systolic strain rate are sensitive to acute changes in load, an important factor that needs to be considered in their application as indices of systolic function.
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              Subclinical abnormalities of left ventricular myocardial deformation in early-stage chronic kidney disease: the precursor of uremic cardiomyopathy?

              Abnormal left ventricular (LV) deformation is an independent predictor of poor cardiovascular outcome in end-stage renal disease. Studies in early-stage chronic kidney disease (CKD) have not been performed despite the known graded inverse relationship between glomerular filtration rate and adverse cardiovascular events. Forty patients with CKD stage 2 or 3 and no history of cardiovascular disease or diabetes and 30 healthy controls underwent Doppler myocardial imaging for longitudinal deformation (strain/strain rate). There were no differences in LV ejection fraction or systolic tissue Doppler velocities between patients with CKD and controls. In CKD, mean global strain (-15% +/- 4% vs -17% +/- 3%, P <.01) and mean global strain rate were reduced compared with controls (-0.88 +/- 0.16 vs -1.06 +/- 0.31, P <.05). Peak systolic strain was reduced in the basal lateral (-13.9% +/- 0.9% vs -17.9% +/- 1.02%, P <.01), basal septal (-17.1% +/- 0.8% vs -19.4% +/- 0.77%, P <.05), and mid-septal (-16.4% +/- 0.78% vs -18.9% +/- 0.88%, P <.05) walls with more basal postsystolic shortening (P <.01). Peak systolic strain rate was reduced in the basal lateral, mid-lateral, and mid-septal segments (P <.05). Conventional measures of systolic function are preserved in early-stage CKD, but systolic deformation is abnormal, consistent with an adverse cardiovascular prognosis.

                Author and article information

                Am J Nephrol
                American Journal of Nephrology
                S. Karger AG
                January 2011
                17 December 2010
                : 33
                : 1
                : 84-90
                aDepartment of Internal Medicine, National Cheng Kung University College of Medicine and Hospital, Tainan, bDivision of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital Dou-Liou Branch, and cDivision of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin, dDivision of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, and eDivision of Nephrology, Department of Internal Medicine, Catholic Fu-An Hospital, Yun-Lin, Taiwan
                Author notes
                *Wei-Chuan Tsai, MD, 138, Shengli Road, Tainan 704 (Taiwan), Tel. +886 6235 3535, Fax +886 6275 3834, E-Mail wctsai@ksmail.seed.net.tw
                322709 Am J Nephrol 2011;33:84–90
                © 2010 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                : 04 October 2010
                : 09 November 2010
                Page count
                Figures: 3, Tables: 3, Pages: 7
                Original Report: Patient-Oriented, Translational Research

                Cardiovascular Medicine,Nephrology
                Chronic kidney disease,End-stage renal disease,Heart function,Speckle-tracking echocardiography,Strain


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