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.