Early LV Dysfunction in Stage 3 Chronic Kidney Disease (CKD) Assessed by Stress Based Ventricular Contractility Index

Introduction: Ischemic heart disease is the most important cause of cardiac morbidity and death. Early detection of cardiac deterioration is imperative. To reach a large population safe, easy accessible and reliable non-invasive investigation methods are required. Objectives: Speckle-tracking echocardiography is a new technique founded on pure 2D gray scale ultrasound acquisition and provides non-doppler, angle-independent and objective quantification of myocardial deformation and of left ventricular systolic and diastolic dynamics. Left ventricular dysfunction is a sensitive predictor of cardiovascular atherosclerotic diseases. Methods:We investigated 969 male, self-supporting and ambulant patients, divided in 495 healthy subjects (HS) with documented normal coronary arteries and in 474 coronary patients (CP), treated with multiple stent implantation or bypass surgery. Both groups were divided in three age groups: 40-59y, 60-79y and 80-99y. We measured by speckle-tracking echocardiography the “global longitudinal peak systolic strain average” (GLPSSavg) of the left ventricle, divided in 24 segments, and also the “average peak longitudinal strain of the 5 myocardial segments with the lowest strain values” (Avg5LSS). The more negative the strain value, the better the myocardial contractile reserve. Measurement of sum maximal diameter left atrium plus maximal diameter left ventricle in cm (LALV). Results: For all age groups significant decrease (p1⁄40,000) of GLPSSavg in CP compared with HS but quasi unchanged results with aging. Also statistically significant decrease (p1⁄40,000) of Avg5LSS for all age groups in CP compared with HS but with a tendency to a progressive decrease of Avg5LSS with aging. LALV is in all age groups statistically significantly larger (p1⁄40,000) in CP compared with HS. Progressive increase of LALV with aging. (Table 1)