Quantitative assessment of left ventricular myocardial work in chronic kidney disease patients by a novel non-invasive pressure-strain loop analysis method.

This study aimed to quantitatively evaluate myocardial work (MW) in advanced stage 3-5 chronic kidney disease (CKD) by a novel non-invasive left ventricular (LV) Pressure-strain loop analysis (PSL). 144 patients with CKD were included (68 with stage 3 CKD group, 76 with stage 4/5 CKD group), and 48 healthy patients were recruited as the control group. All subjects had undergone transthoracic echocardiography. LV myocardial work and efficiency were estimated from LV PSL analysis. There was a significant progressive increase in global work waste (GWW) and reduction in global work efficiency (GWE) in CKD compared to normal controls. No difference in global work index (GWI) and global constructive work (GCW) was observed among the three groups. Subdivided analysis according to systolic blood pressure (SBP) and LV geometry discovered that increased GWW seems to be present frequently in CKD patients with elevated SBP or LV hypertrophy (LVH). Multivariate analysis showed increased peak strain dispersion (PSD), SBP, LV mass index (LVMI), and decreased estimated glomerular filtration rate (eGFR) were significantly associated with increased GWW. The decline of renal function followed by impaired paralleled myocardial energy exploitation. Moreover, increased PSD, SBP, LVMI, and decreased eGFR might be potential drivers of increased GWW.