International Journal of Cardiology

International Journal of Cardiology | Vol. 12, No. 10, October 2021 | pp. 73–80

DOI: 10.46882/2021/IJC/000151

Original Research Article

Prognostic Significance of Longitudinal Ventricular Strain in Patients with Severe Chronic Kidney Disease and Aortic Stenosis

Hans-Jürgen Schmidt¹, Werner Müller¹, Dieter Reinhardt²

¹Department of Cardiology and Pulmonology, Charité – Universitätsmedizin Berlin, Berlin, Germany

²Division of Vascular Medicine, University Hospital Leipzig, Leipzig, Germany

Abstract:
Valvular aortic stenosis (AS) in patients with advanced chronic kidney disease (CKD) accelerates myocardial remodeling, yielding an increased hazard profile. Standard metrics such as left ventricular ejection fraction (LVEF) often fail to capture subclinical contractile dysfunction caused by concurrent uremic cardiomyopathy. This prospective study evaluated the prognostic value of two-dimensional global longitudinal strain (GLS) in asymptomatic or minimally symptomatic patients with severe AS and stage 4 CKD. We enrolled 125 patients with an aortic valve area less than 1.0 cm², preserved LVEF (greater than or equal to 50%), and an estimated glomerular filtration rate (eGFR) between 15 and 29 mL/min/1.73m². All participants underwent speckle-tracking echocardiography at baseline. The primary endpoint was a composite of cardiac mortality or heart failure hospitalization over a 24-month follow-up period. Impeared baseline structural mechanics, defined as an absolute GLS less than 15.0%, was present in 44.0% of the cohort. At 24 months, the primary composite endpoint occurred in 42 patients (33.6%). Kaplan-Meier survival curves indicated a significantly lower event-free survival rate in the low absolute GLS group (51.2% vs. 81.3%, log-rank p < 0.001). After adjusting for age, eGFR, and plasma NT-proBNP levels, multivariable Cox proportional hazards analysis confirmed that an absolute GLS less than 15.0% was an independent predictor of the composite outcome (hazard ratio: 2.26, 95% CI: 1.38–3.68, p = 0.001). Quantitative baseline global longitudinal strain serves as an independent predictor of adverse outcomes in patients with severe aortic stenosis complicated by advanced renal dysfunction.

Keywords: Aortic stenosis, Chronic kidney disease, Global longitudinal strain, Echocardiography, Risk stratification, Cardiorenal syndrome

Received: July 02, 2021; Revised: August 14, 2021; Accepted: September 05, 2021; Published: October 18, 2021

Subscribe to read the full article: https://www.internationalscholarsjournals.org/subscribe-to-read