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Abstract: FR-PO1025

Global Longitudinal Strain on Cardiac MRI Is Superior to Conventional Cardiac Parameters at Predicting Mortality in Patients with ESRD

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Zhu, Luke Yanyang, University of Glasgow, Glasgow, United Kingdom
  • Mangion, Kenneth, University of Glasgow, Glasgow, United Kingdom
  • Rutherford, Elaine, University of Glasgow, Glasgow, United Kingdom
  • Gillis, Keith, University of Glasgow, Glasgow, United Kingdom
  • Lees, Jennifer S., University of Glasgow, Glasgow, United Kingdom
  • Patel, Rajan, University of Glasgow, Glasgow, United Kingdom
  • Roditi, Giles, University of Glasgow, Glasgow, United Kingdom
  • Mark, Patrick B., University of Glasgow, Glasgow, United Kingdom
  • Rankin, Alastair J., University of Glasgow, Glasgow, United Kingdom
Background

Left Ventricular Global Longitudinal Strain (LV-GLS) by Feature Tracking Cardiac Magnetic Resonance (FT-CMR) is a non-contrast, post-processing technique that has shown promise as a sensitive predictor of cardiovascular mortality. We aim to assess the ability of LV-GLS to predict death in patients with end-stage renal disease (ESRD).

Methods

We retrospectively analysed research cardiac MRIs (CMR) performed at a major renal transplant centre between 2002-2016. Included patients were receiving, or within 6-months of receiving, renal replacement therapy for ESRD. CMR parameters were derived, including left ventricular mass index (LVMI), LV ejection fraction (LVEF), left atrial ejection fraction (LAEF), and LV-GLS. Cox proportional hazards regression analyses were used to identify potential predictors of all-cause death. Model fit was assessed using the C-statistic.

Results

Among 237 patients (mean age: 53.7, 61% male), mortality was 50.6% over 4.6-year median follow up. LV-GLS quartiles were significantly correlated with mortality (Figure 1). While 89.7% of patients had preserved LVEF (>55%), 24% of patients had abnormal LV-GLS. On multivariable Cox regression, age (HR: 1.04, 95% CI: 1.020-1.057), LAEF (HR: 0.98, 95% CI: 0.963-0.997) and LV-GLS (HR: 1.08, 95% CI: 1.011-1.044) were independent predictors of mortality. The C-statistic of this model for predicting ACM at 1-year was 0.955 (95% CI: 0.920-0.991). Traditional CMR parameters such as LVEF and LVMI were not correlated with mortality.

Conclusion

In this cohort of patients with ESRD, LV-GLS and LAEF as measured on FT-CMR demonstrate independent predictive utility for all-cause death, whilst conventional imaging biomarkers such as LVEF did not. The effect was present even with normal LVEF. LVGLS has a potential role in the prognostication and pre-transplant assessment of patients with ESRD.

Funding

  • Government Support - Non-U.S.