Evaluation of the left ventricular regional function using two-dimensional speckle tracking echocardiography in patients with end-stage renal disease with preserved left ventricular ejection fraction.

OBJECTIVE: It is known that patients with end-stage renal disease (ESRD) more frequently develop a wide range of left ventricular (LV) structural and functional abnormalities. The aim of our study is to evaluate the left ventricular regional function using two-dimensional speckle tracking echocardiography (2D-STE) in ESRD patients with preserved left ventricular ejection fraction (PLVEF) undergoing haemodialysis treatment.

METHODS AND RESULTS: In total 61 healthy individuals and 87 ESRD patients were enrolled. Using the 2D-STE method, the strain (S) and strain rate (SR(S): systolic, SR(E): early diastolic, SR(A): late diastolic) values belonging to the radial (R), circumferential (C), and longitudinal (L) functions of the LV have been measured and the SR(E/A) values were calculated. While the LVEF values in the ESRD group were found to be lower than in the healthy control group (64.39 +/- 5.7 vs. 65.49 +/- 3.95, P = 0.033; R(S) = 45.17 +/- 17.28 vs. 53.97 +/- 14.29, P = 0.001; L(S) = -19.71 +/- 3.1 vs. -30.13 +/- 2.1, P < 0.001; RSRE(E/A) = 1.55 +/- 0.85 vs. 2.04 +/- 0.96, P = 0.001; LSR(E/A) = 1.42 +/- 0.51 vs. 1.88 +/- 0.7, P < 0.001), no difference was observed in terms of the C(S) (19.42 +/- 7.14 vs. 18.57 +/- 4.12, P = 0.155) and CSR(E/A) (2.5 +/- 1.34 vs. 2.56 +/- 1.35, P = 0.869) values. The C(S) was observed as an independent predictor related to the LVEF (beta = 0.2, 95% CI: 0.126-0.207, P = 0.015).

CONCLUSION: In patients with ESRD, although the longitudinal and radial systolic functions are reduced, the LVEF may remain within normal limits due to the preservation of the circumferential functions. 2D-STE has the potential to detect the severity of uraemic cardiomyopathy in the early stages of the disease and might provide useful information for the risk stratification in ESRD patients with PLVEF.