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Multicenter Study
. 2024 Nov;113(11):1576-1588.
doi: 10.1007/s00392-024-02459-6. Epub 2024 May 15.

Myocardial work in chronic kidney disease: insights from the CPH-CKD ECHO Study

Flemming Javier Olsen  1   2 , Nino Emanuel Landler  3   4 , Jacob Christensen  3   4 , Bo Feldt-Rasmussen  5   6 , Ditte Hansen  6   7 , Christina Christoffersen  4   8 , Ellen Linnea Freese Ballegaard  5   6 , Ida Maria Hjelm Sørensen  5 , Sasha Saurbrey Bjergfelt  4   5 , Eline Seidelin  7 , Susanne Bro  5 , Tor Biering-Sørensen  3   4   9   10
Affiliations
Multicenter Study

Myocardial work in chronic kidney disease: insights from the CPH-CKD ECHO Study

Flemming Javier Olsen et al. Clin Res Cardiol. 2024 Nov.

Abstract

Background: Myocardial work is a novel echocardiographic measure that offers detailed insights into cardiac mechanics. We sought to characterize cardiac function by myocardial work in patients with chronic kidney disease (CKD).

Methods: We prospectively enrolled 757 patients with non-dialysis-dependent CKD and 174 age- and sex-matched controls. Echocardiographic pressure-strain loop analysis was performed to acquire the global work index (GWI). Linear regressions were performed to investigate the association between estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (UACR) to GWI.

Results: Patients with CKD had a mean age of 57 years, 61% were men, and median eGFR was 42 mL/min/1.73 m2. Overall, no difference in GWI was observed between patients and controls (1879 vs. 1943 mmHg%, p = 0.06). However, a stepwise decline in GWI was observed for controls vs. patients with CKD without left ventricular hypertrophy vs. patients with CKD and left ventricular hypertrophy (GWI, 1943 vs. 1887 vs. 1789 mmHg%; p for trend = 0.030). In patients with CKD, eGFR was not associated with GWI by linear regression. However, diabetes modified this association (p for interaction = 0.007), such that per 10 mL/min/1.73 m2 decrease in eGFR, GWI decreased by 22 (9-35) mmHg% (p = 0.001) after multivariable adjustments in patients without diabetes, but with no association between eGFR and GWI in patients with diabetes. No association was observed between UACR and GWI.

Conclusion: Patients with CKD and left ventricular hypertrophy exhibited lower myocardial work compared to matched controls. Furthermore, decreasing eGFR was associated with decreasing myocardial work only in patients without diabetes. No association to UACR was observed.

Keywords: Chronic nephropathy; Kidney disease; Myocardial work; Pressure-strain.

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Conflict of interest statement

D.H.: Steering Committee member of the Boehringer Ingelheim financed SHARP3 trial. Advisory Board: GSK. Lecture fee: Astra Zeneca and UCB Nordic. E.L.F.B.: Received non-related research grants from AstraZeneca. T.B-S.: Steering Committee member of the Amgen financed GALACTIC-HF trial. Primary investigator of the Sanofi Pasteur financed “NUDGE-FLU” trial. Primary investigator of the Sanofi Pasteur financed “DANFLU-1” trial. Primary investigator of the Sanofi Pasteur financed “DANFLU-2” trial. Steering Committee member of “LUX-Dx TRENDS Evaluates Diagnostics Sensors in Heart Failure Patients Receiving Boston Scientific’s Investigational ICM System” trial. Steering Committee member of the Boehringer Ingelheim financed SHARP3 trial. Advisory Board: Sanofi Pasteur, Amgen, and GSK. Speaker Honorarium: Novartis, Sanofi Pasteur, GE Healthcare, and GSK. Research grants: GE Healthcare, AstraZeneca, Novo Nordisk and Sanofi Pasteur. The other authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
The pressure-strain loop analysis process used to obtain myocardial work measures. First, left ventricular speckle tracking is performed (top left panel), then the brachial artery blood pressure is added, and then the timing of valvular opening and closure is visually estimated (top right panel with orange arrow at the mitral valve and green arrow at the aortic valve). The results are depicted in the bottom left panel and include a pressure-strain loop with the area reflecting global myocardial work index, the bulls-eye plot shows segmental values of myocardial work, and bar charts show the relative distribution of constructive and wasted work. The bottom right panel presents definitions of the four work measures derived from the pressure-strain loop analysis
Fig. 2
Fig. 2
Distribution of myocardial work and longitudinal strain. Separated scatter plot illustrating how measures of global longitudinal strain and myocardial work were distributed according to abnormalities in strain and work
Fig. 3
Fig. 3
The association between eGFR and the global work index in patients without diabetes (top left panel) and patients with diabetes (top right panel). In addition, the association between eGFR and global constructive work is also depicted in patients without diabetes (bottom left panel) and patients with diabetes (bottom right panel). CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate
Fig. 4
Fig. 4
Based on logistic regression, these figures illustrate the association between eGFR and the probability of having abnormal GWI (top left panel), GCW (top right panel), GWW (bottom left panel), and GWE (bottom right panel) after multivariable adjustments in patients without diabetes. eGFR, estimated glomerular filtration rate; GWI, global work index; GCW, global constructive work; GWW, global wasted work; GWE, global work efficiency
See this image and copyright information in PMC

References

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