Background

Patients with advanced chronic kidney disease (CKD) have high risk for sudden cardiac death (SCD) and may benefit from implantable cardioverter-defibrillators (ICDs). However, the risk for ICD-related complications is also high in this population. Therefore, there is an unmet need for accurate risk stratification tools to identify patients with CKD at risk for ventricular arrhythmias (VAs), who may benefit from ICD implantation. The aim of this hypothesis-generating study was to investigate the association between left ventricular (LV) mechanical dispersion and LV global longitudinal strain (GLS) measured using two-dimensional speckle-tracking echocardiography and VA and SCD in patients with CKD.

Methods

Patients with CKD stages 3b to 5 (estimated glomerular filtration rate < 45 mL/min/1.73 m² or on dialysis) were included and were divided into two groups according to the occurrence of VA or SCD during follow-up. LV mechanical dispersion, as a measure of the temporal heterogeneity of the LV deformation, was measured as the SD of time to peak longitudinal strain of 17 LV segments. The ability of LV mechanical dispersion, LV ejection fraction, and LV GLS to discriminate patients with VA or SCD during follow-up was evaluated using receiver operating characteristic curve analysis.

Results

Of 250 patients (66% men; mean age, 61 ± 14 years), 16 (6%) experienced VA or SCD during a median follow-up duration of 28 months (interquartile range, 16–53 months). Using receiver operating characteristic curve analyses, LV GLS (area under the curve = 0.79; 95% CI, 0.68–0.89) and LV mechanical dispersion (area under the curve = 0.71; 95% CI, 0.61–0.82) showed modest discrimination to identify patients at risk for VA or SCD. In contrast, LV ejection fraction showed poor discrimination (area under the curve = 0.60; 95% CI, 0.41–0.78).

Conclusions

LV mechanical dispersion along with LV GLS may be an additional valuable risk marker of VA and SCD in predialysis and dialysis patients.

中文翻译：

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透析前和透析患者的左心室机械分散和整体纵向应变和心律失常

背景

患有晚期慢性肾脏病（CKD）的患者有突发性心脏猝死（SCD）的高风险，并且可能会受益于植入式心脏复律除颤器（ICD）。但是，该人群中与ICD相关的并发症的风险也很高。因此，迫切需要精确的风险分层工具来识别有室性心律失常（VAs）风险的CKD患者，这些患者可能受益于ICD植入。这项假设产生研究的目的是研究二维散斑跟踪超声心动图和VA和SCD对CKD患者的左心室（LV）机械分散与左室总纵应变（GLS）之间的关系。

方法

纳入CKD 3b至5级（估计肾小球滤过率<45 mL / min / 1.73 m ²或透析）的患者，并根据随访期间VA或SCD的发生情况将其分为两组。LV机械弥散，作为LV变形的时间异质性的一种度量，被测量为达到17个LV段纵向峰值应变的时间的SD。使用受试者工作特征曲线分析评估了随访期间左心室机械分散，左心室射血分数和左心室GLS区分VA或SCD患者的能力。

结果

在250位患者（66％的男性；平均年龄61±14岁）中，有16位（6％）在中位随访28个月（四分位间距为16-53个月）期间经历了VA或SCD。使用接收器工作特性曲线分析，LV GLS（曲线下面积= 0.79； 95％CI，0.68–0.89）和LV机械色散（曲线下面积= 0.71； 95％CI，0.61-0.82）显示出适度的鉴别力有VA或SCD风险的患者。相反，左室射血分数显示差的辨别力（曲线下面积= 0.60； 95％CI为0.41-0.78）。

结论

在透析前和透析患者中​​，LV机械分散以及LV GLS可能是VA和SCD的另一个有价值的危险标志。