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Comparative Study
. 2025 Jul 31;26(1):425.
doi: 10.1186/s12882-025-04368-w.

Retrospective comparison of left ventricular systolic dysfunction assessed by left ventricular global longitudinal strain in hemodialysis patients with preserved left ventricular ejection fraction and patients with hypertensive left ventricular hypertrophy

Michiya Ohno  1 , Tomonori Segawa  2 , Tetsuo Noda  3 , Yoshinari Yasuda  4 , Junichiro Yamamoto  5
Affiliations
Comparative Study

Retrospective comparison of left ventricular systolic dysfunction assessed by left ventricular global longitudinal strain in hemodialysis patients with preserved left ventricular ejection fraction and patients with hypertensive left ventricular hypertrophy

Michiya Ohno et al. BMC Nephrol. .

Abstract

Background: Multiple factors, including hypertension, affect left ventricular remodeling in hemodialysis (HD) patients. Therefore, this retrospective study used left ventricular global longitudinal strain (GLS), an excellent method for detecting mild left ventricular systolic dysfunction, to compare left ventricular systolic function in HD patients with preserved left ventricular ejection fraction (LVEF) and patients with hypertensive left ventricular hypertrophy (HLVH).

Methods: Participants were aged 60 years or older and had an LVEF of 60% or higher. We compared 20 HD patients (HD group) with 20 HLVH patients matched for age and sex (HLVH group) and 20 healthy control individuals (C group). GLS decline was defined as a GLS value greater than the GLS reference value, which was the mean value of + 2×standard deviation in the C group.

Results: LVEF was not significantly different between the 3 groups, but GLS was significantly worse in the HD group (-15.8%±1.4%) than in the C group (-19.3%±1.1%, p < 0.01) and HLVH group (-17.0%±1.4%, p < 0.05). Relative wall thickness (RWT) and left ventricular mass index (LVMI) were significantly higher in the HLVH and HD groups than in the C group (p < 0.01), and hemoglobin (Hb) levels were significantly lower in the HD group than in the C and HLVH groups (p < 0.01). The frequency of GLS decline (i.e., GLS > -17.0%) was significantly higher in the HD group than in the HLVH group (p < 0.01). Multiple regression analysis of the 3 groups showed that increased RWT and LVMI and decreased Hb were significantly associated with GLS decline (p < 0.01).

Conclusions: HD patients with preserved LVEF have a significantly greater decline in GLS than HLVH patients. Increased RWT and LVMI with renal anemia may contribute to GLS decline in HD patients with LVEF.

Clinical trial number: 2023-01-02.

Keywords: Hemodialysis; Hypertensive left ventricular hypertrophy; Left ventricular global longitudinal strain; Two-dimensional speckle tracking.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The present study was conducted in accordance with the principles of the Declaration of Helsinki and approved by the Research Ethics Committee of Asahi University Hospital (approval number 2023-01-02). Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Measurement of global longitudinal strain. Global longitudinal strain (GLS) analysis of the stored image data of extracted cases was performed on the left long axis by the two-dimensional (2D) speckle tracking method with AutoSTRAIN (Philips). Three cross sections were evaluated: apical long axial cross-section (A3c), 4-chamber cross-section (A4c), and 2-chamber cross-section (A2c). GLS, global longitudinal strain
Fig. 2
Fig. 2
Comparison of global longitudinal strain between the 3 groups. Distribution of global longitudinal strain (GLS) in each group and mean ± SD GLS values are shown. Blue circles, control group; orange circles, hypertensive left ventricular hypertrophy group; and black circles, hemodialysis group. C, control; GLS, global longitudinal strain; HD, hemodialysis; HLVH, hypertensive left ventricular hypertrophy
Fig. 3
Fig. 3
Correlation between global longitudinal strain and relative wall thickness. Regression line obtained from a simple regression analysis of the 3 groups is shown. At a global longitudinal strain decline greater than − 17% (the reference value calculated from the control group), the relative wall thickness was 0.58. Blue circles, control group; orange circles, hypertensive left ventricular hypertrophy group; and black circles, hemodialysis group. C, control; GLS, global longitudinal strain; HD, hemodialysis; HLVH, hypertensive left ventricular hypertrophy
See this image and copyright information in PMC

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