Prognostic value of left ventricular global longitudinal strain in chronic kidney disease patients: a systematic review
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NEPHROLOGY - ORIGINAL PAPER
Prognostic value of left ventricular global longitudinal strain in chronic kidney disease patients: a systematic review and meta‑analysis Tao Zhang1 · Jing Li2 · Shili Cao1 Received: 2 January 2020 / Accepted: 2 May 2020 © Springer Nature B.V. 2020
Abstract Objective The objective of this meta-analysis was to evaluate whether left ventricular global longitudinal strain (GLS) is a potential marker of predicting adverse outcomes in CKD patients. Background CKD is a growing health burden currently affecting 10–15% of adults worldwide, and disproportionally increasing propensity to develop cardiovascular diseases and events. Although obtained from several relatively small studies, the evidence supporting the prognostic value of GLS in patients with CKD is still building. Methods We conducted a Medline literature research using electronic databases (PubMed, Ovid, Embase and Web of Science) to identify relevant studies reporting the association between GLS and the primary outcomes, including all-cause mortality, major cardiac events (MCE), and cardiovascular mortality in CKD patients. Sensitivity analysis and subgroup analysis were performed to find the origin of heterogeneity. Results A total of 11 observational studies with 2167 patients with CKD were enrolled. In patients with CKD, GLS was associated with all-cause mortality (HR: 1.09, 95% CI 1.06–1.12) with no heterogeneity among the studies (I2 = 46.5%, P = 0.06). In addition, GLS was associated with MCE and cardiovascular mortality with no heterogeneity (HR 1.16, 95% CI 1.11–1.22; HR 1.18, 95% CI 1.12–1.24, respectively). Overall, GLS was also associated with combined adverse events in CKD patients (HR 1.09, 95% CI 1.07–1.12) with moderate heterogeneity (I2 = 51.2%, P = 0.025). Conclusions Our meta-analysis demonstrates that GLS is associated with all-cause mortality, MCE, cardiovascular mortality, and combined adverse events in CKD patients. Keywords Chronic kidney disease · Left ventricular global longitudinal strain · Left ventricular ejection fraction · Adverse outcomes · All-cause mortality
Introduction Patients with chronic kidney diseases (CKD) exhibit a dramatically increased risk for cardiovascular morbidity and mortality as a result of prolonged exposure to an evergrowing array of traditional and non-traditional risk factors [1]. These risk factors exert pressure on myocardium and * Jing Li [email protected] * Shili Cao [email protected] 1
Department of Nephrology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300112, People’s Republic of China
Department of Nephrology, First Central Hospital of Tianjin, Tianjin 300192, People’s Republic of China
2
blood vessels itself, resulting in uremic cardiomyopathy particularly in end-stage renal disease (ESRD) patients that is characterized by cardiac fibrosis, capillary rarefaction, left ventricular (LV) hypertrophy, and both systolic and diastolic dysfunction. If dialysis is initiated, the aforementioned risk may be aggravated,
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