Non-invasive left ventricular pressure-strain loops for quantitative assessment of early left ventricular systolic dysfunction in patients with chronic kidney disease

Objective: To investigate the value of the left ventricular pressure-strain loop (LVPSL) for quantitative assessment of myocardial work (MW) in patients with chronic kidney disease (CKD), and to analyze the factors influencing MW. Methods: : Retrospective analysis of 75 patients with CKD (37 patients with CKD stages 2-3, and 38 patients with CKD stages 4-5) and 35 healthy volunteers between March and August 2022. Global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE) were obtained by echocardiography, and the differences between the groups were compared.These parameters were further analyzed for correlation with conventional echocardiographic indices, global longitudinal strain (GLS), and the characteristics of participants. Results: : GWE and GLS were reduced and GWW was increased in the CKD group (all P <0.001). GWW was higher and GWE was lower in CKD stages 4-5 than in CKD stages 2-3 (all P <0.01). Multiple linear regression revealed that age, serum creatinine, and GLS influenced GWE (β = -0.054, P = 0.005; β = -0.003, P = 0.020; β = -0.563, P <0.001, respectively), whereas age, serum creatinine, and systolic pressure influenced GWW (β = 1.362, 0.068, 1.167, P = 0.001, 0.016, 0.003, respectively). Conclusion: LVPSL can be used for non-invasive quantitative assessment of MW in patients with CKD, providing a new sensitive approach for the clinical assessment of myocardial function. Increased age, serum creatinine and systolic pressure may be potential drivers of increased GWW, whereas increased age, serum creatinine and decreased GLS may be potential drivers of decreased GWE, thereby providing some reference for the clinical treatment of CKD