Echocardiographic Evaluation of Left Ventricular Function in Patients With Chronic Kidney Disease

Abstract

Cardiovascular Morbidity and Mortality are closely linked to chronic kidney disease(CKD).Even in the early stages of chronic kidney disease,cardiac structural and functional abnormalities are very common ,especially involving the left ventricle. Patients with chronic kidney disease frequently exhibit left ventricular hypertrophy,systolic andistolic dysfunction,and altered LV geometry. These anomalies may be subclinical at first, but can gradually worsen global cardiac function,making it harder for the heart to sustain sufficient circulation. Heart failure is common in Chronic kidney disease patients and is closely ralted to abnormalities in left ventricular function.Impaired left ventricular systolic or diastolic function can reduce cardiac output while increasing ventricular filling pressures,eventually leading to Heart failure.  Echocardiography is a widely accessible,non-invasive imaging technique that enables evaluation of systolic and diastolic function of the left ventricle.Observational-cross sectional study was conducted on 82 patients with Chronic kidney disease.Renal function was assessed using  urea,serum creatinine and estimated glomerular filteration rate(eGFR).Echocardiography were performed to evaluate left ventricular systolic and diastolic function.LV systolic function was assessed using   left ventricular ejection fraction.LV diastolic function was assessed using mitral E velocity,A velocity,E/A ratio,deceleration time and E/e’ ratio.The relationship between renal function and echocardiographic findings was analysed using appropriate statistical tests.

82 patients were included in this study.75.6% of the patients had stage 5 chronic kidney disease.54.46 ±11.83 was the mean age.Assessment of LV systolic function showed that age was significantly associated with LV systolic dysfunction (p < 0.001). A significant association was also observed between duration of CKD and LV systolic dysfunction (p=0.04). However, gender, BMI, serum creatinine, eGFR, and CKD stage were not significantly associated with LV systolic dysfunction. For diastolic function, the mean E velocity was 0.68 ± 0.21 m/s, E/A ratio 0.97 ± 0.51, deceleration time 182.61 ± 30.13 ms, and E/E′ ratio 9.09 ± 2.96. No significant association was observed between the studied demographic or renal parameters and LV diastolic dysfunction. Correlation analysis showed weak and statistically non-significant relationships between renal function parameters and echocardiographic indices due to the small sample size and the predominance of stage 5 CKD in the study population.Systolic and diastolic abnormalities were seen in patients with chronic kidney disease(CKD).Older age and longer duration of CKD were significantly associated with LV systolic dysfunction.The echocardiographic indices of left ventricular function,however,did not significantly correlate with renal function parameters.These results highlights the importance of echocardiographic evaluation for early detection of cardiac dysfunction in patients with chronic kidney disease,particularly in those who are older or have had kidney disease for longer period of time.