Introduction

Chronic kidney disease (CKD) is an important cardiovascular risk factor. However, the relationship between CKD and myocardial strain as a parameter of myocardial function is still incompletely understood. Cardiac magnetic resonance imaging (CMR) is a promising tool to analyze myocardial strain with high reproducibility. Therefore, the aim of the present study was to assess the relationship between CKD and myocardial strain as described by CMR.

Methods

We retrospectively performed CMR-based myocardial strain analysis in 78 patients with ischemic cardiomyopathy (ICM) and different stages of CKD, classified according to the KDIGO-classes. In all patients, global longitudinal strain (GLS), global circumferential strain (GCS) and global radial strain (GRS) analysis of left ventricular myocardium were performed. Furthermore, segmental longitudinal (SLS), circumferential (SCS) and radial strain (SRS) of all segments according to the AHA 16/17-segment model was determined.

Results

Both urea levels (GLS: r= 0.38, p=0.001; GCS: r=0.29, p=0.010; GRS: r=0.29, p=0.009) as well as estimated glomerular filtration rate (GLS: r=0.33, p=0.003; GCS: r=0.214, p=0.059; GRS r=0.29, p=0.009) were associated with global strains as determined by CMR. To further investigate the relationship between CKD and myocardial dysfunction, segmental strain analysis was performed: SLS was progressively impaired with increasing severity of CKD (KDIGO-1: -11.42±3.53%; KDIGO-5: -6.65±3.59%; p<0.001 for KDIGO-5 vs. KDIGO-1; similar data for SCS and SRS). Interestingly, myocardial strain was impaired with CKD in both, segments with and without scarring. Furthermore, the impairment in myocardial strain with CKD was not related to more extensive scarring (KDIGO-1: 5.57±2.82 scarred segments vs. KDIGO-5: 4.5±3.54 scarred segments, p=ns).

Conclusion

CKD is related to impaired LV strain as assessed by CMR in patients with ICM. In our cohort this relationship is independent of the extent of myocardial scarring.