Role of 2D Speckle Tracking Echocardiography in Detecting Subclinical Abnormalities of Left Ventricular Systolic Function in Chronic Renal Failure Patients with Normal Ejection Fraction

Abstract

C hronic kidney disease (CKD) is a global problem, gaining importance day after another. CKD burden increases due to increased prevalence of hypertension, diabetes Mellitus, and cardiovascular diseases. CVDs are the major cause of death in hemodialysis patients accounting for up to 45% of all deaths. Speckle-tracking echocardiography has emerged as a quantitative technique for evaluating myocardial function. This study included 80 individuals subdivided into three groups: end stage renal disease on regular hemodialysis, hypertensive and control group, all with a preserved ejection fraction by 2D echocardiography on initial examination. The aim of the study was to identify the early markers of cardiovascular diseases in end stage renal disease patients using speckle tracking echocardiography. After a detailed history, all patients were assessed clinically followed by M-Mode and 2D echocardiographic assessment, pulsed wave Doppler, tissue Doppler imaging as well as offline speckle tracking echocardiography assessment of LV systolic function (longitudinal strain pattern and torsion). Our results showed that hypertension and DM are highly prevalent in patients with ESRD. Significant increase in LV volumes and dimensions, LA volume, LV mass and LV diastolic dysfunction was noticed in patients with ESRD. Furthermore, despite preserved LV systolic function, as revealed by conventional echocardiographic assessment, ESRD is associated with a sub clinical reduction of systolic function as reflected by the decline of LV GLS which was also reduced in the hypertensive group Peak LV torsion didn’t show significant difference between ESRD, hypertensive and control groups. Of notice, most of these changes didn’t differ significantly from the hypertensive group.