A comparative analysis of conventional and speckle-tracking strain echocardiographic findings in diabetic and non-diabetic kidney disease patients with normal ejection fraction

Abstract

This study aimed to compare the differences in echocardiographic and strain parameters in patients with diabetic kidney disease (DKD) and non-diabetic kidney disease (NDKD) in a cohort with pre-dialysis chronic kidney disease (CKD) and normal ejection fraction (EF). In this single-center prospective study, patients with CKD stages 3-5 and EF > 55% were included. We compared cardiac structure and function using conventional and speckle-tracking strain echocardiography among DKD and NDKD groups. Cardiovascular outcomes were assessed at the end of the study. Of the included 117 patients, 56 (47.9%) had DKD, and 61 (52.1%) had NDKD. Patients with DKD had higher ratios of early mitral inflow velocity and mitral annular early diastolic velocity (E/e') (11.9 ± 4.4 vs. 9.8 ± 3.5; p = 0.004), lower septal e' velocity (7.1 ± 2.5 vs. 8.2 ± 2.8; p = 0.031), lower lateral e' velocity (9.2 ± 2.9 vs. 10.4 ± 3.8; p = 0.045) and longer deceleration times (209.2 ± 41.5 vs. 189.1 ± 48.0; p = 0.017), compared to those with NDKD. Left ventricular mass index (LVMI), global longitudinal strain (GLS), early diastolic strain rate (SR_E), and E/SR_E were similar. At a median follow-up of 239 days, 3-P MACE (11.5% vs. 4.9%; p = 0.047) and 4-P MACE (28.6% vs. 11.5%; p = 0.020) were observed to be higher in the DKD group. Diastolic dysfunction was more common in patients with DKD, compared to those with NDKD, although both groups had similar LVMI and GLS. Those with DKD also had poorer cardiovascular outcomes. This highlights the importance of the assessment of diastolic function in CKD, particularly in those with diabetic CKD.

Keywords: Atherosclerotic cardiovascular disease; Cardiovascular outcomes; Chronic kidney disease; Deformation imaging; Diabetic kidney disease; Diabetic nephropathy; Diastolic dysfunction; Major adverse cardiovascular events; Speckle-tracking; Strain echocardiography; Strain imaging.

Fig. 1

Doppler and strain echocardiographic images. Top left, pulsed-wave doppler recording at mitral inflow showing E, A velocities and E-wave DT. Top right, tissue doppler imaging at lateral mitral annulus showing e’. Mid left, region of interest tracing in the apical 4-chamber view during offline analysis using semi-automatic speckle-tracking software. Mid right, segments of left ventricle as seen in the apical 4-chamber view. Bottom left, peak systolic strain waveform obtained from apical 4-chamber view shown in mid panel. Bottom right, Bull's eye plot of longitudinal strain 3 apical views showing strain values of each segment