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Nephrologie 21. September 2016

Incremental value of global longitudinal strain in prediction of all-cause mortality in predialysis and dialysis chronic kidney disease patients

Background: The aim of this prospective study was to investigate the prediction of all-cause mortality from global longitudinal strain (GLS) in two groups of chronic kidney disease patients (CKD): predialysis and dialysis.

Methods: In 89 patients undergoing echocardiography, 37.2 % predialysis (16/43) and 58.6 % dialysis patients (27/46) died during the mean follow-up 70.2 ± 35 months. In addition to conventional echocardiographic measurements, GLS was assessed by velocity vector imaging from three standard apical views.

Results: Cox proportional hazards regression enter model showed the following variables to predict survival: the only significant predictor of survival in predialysis patients, among the set of conventional echocardiographic parameters was GLS (HR, 0.58; 95 % CI, 0.39–0.87; p = 0.01). In the group of dialysis patients GLS with E/Em ratio remained as significant predictors of survival (HR, 0.72; 95 % CI, 0.56–0.92; p = 0.01, and HR, 1.02; 95 % CI, 1.004–1.04; p = 0.01, respectively). GLS ≥ − 13.2 % had 58.3 % sensitivity and 91.7 % specificity for prediction of mortality in predialysis patients, and GLS ≥ − 12.02 % had 73.3 % sensitivity and 78.9 % specificity for prediction of mortality in dialysis patients. In dialysis group E/Em ratio ˃ 17.02 had 71.4 % sensitivity and 84.2 % specificity for prediction of mortality.

Conclusions: Our study demonstrates the incremental value of GLS in prediction of all-cause mortality during a long follow-up period in CKD patients. GLS together with E/Em ratio may be used for the assessment of left ventricular systolic and diastolic function and risk stratification of CKD patients in different stages of renal failure.

Ivana Valocikova, Marianna Vachalcova, Gabriel Valocik, Marian Kurecko, Mariana Dvoroznakova, Peter Mitro, Jozefina Cocherova, Stanislava Bujnakova, Dusan Holoubek, Wiener klinische Wochenschrift 13/14/2016

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