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EARLY DIASTOLIC LEFT VENTRICULAR FUNCTION IN AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE: A MATCHED-COHORT, SPECKLE-TRACKING ECHOCARDIOGRAPHIC STUDY

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INTRODUCTION

Autosomal Dominant Polycystic Kidney Disease (ADPKD) is associated with early onset hypertension, left ventricular (LV) hypertrophy and  diastolic dysfunction. Early diastolic untwisting rate has emerged as a sensitive parameter of LV  diastolic function. Two-dimensional speckle tracking echocardiography is a reproducible, non-invasive  technique to quantify LV rotational mechanics throughout the whole cardiac cycle.

Methods

In this pre-specified, matched-cohort study we explored in 35 ADPKD patients with normal renal function or mild to moderate renal insufficiency from the ALADIN study and in 35 -matched controls renal disease no adpkd patients and evaluated the correlates of LV untwisting rate in this population. Speckle tracking echocardiography analysis was performed on 3 consecutive cardiac cycles. Rotation (degrees) and rotation rate (degrees/sec) profiles in basal and apical short-axis planes were measured. Instantaneous  LV twist  and twist rate were calculated by subtracting basal rotation from apical rotation  and basal rotation rate from apical rotation rate, respectively, at corresponding time points in the cardiac cycle. LV untwisting rate was calculated as the early diastolic negative peak on LV twist rate curve. 

Results

The demographic, clinical and main laboratory data from ADPKD patients are listed in the table 1. A considerable percentage of ADPKD patients were hypertensive (68%). As compared to control, patients exhibited similar heart rate and blood pressure (BP), higher LV mass index, left atrium volume, and early diastolic mitral wave ( E) to early diastolic mitral annulus wave (Ea) ratio as well  as lower global systolic longitudinal strain, LV twist and  untwisting rate (Table 2). At multivariate analysis, LV mass index, diastolic BP and LV twist resulted significantly associated to untwisting rate (Table 3).

Conclusions

In conclusion, this study demonstrates an impairment of LV twisting dynamics in patients with early stage of ADPKD and provides insight into the LV diastolic dysfunction. The new parameters of cardiac function, derived from two-dimensional speckle-tracking echocardiography, could be useful for an early diagnosis of cardiac involvement in patients with ADPKD. Whether they can be used to assess the progression of disease and the response to the therapy is an issue to be pursued.

release  1
pubblicata il  26 settembre 2014 
da Antonio Pisani¹, Giuseppe Remuzzi², Piero Ruggenenti², Eleonora Riccio¹, Bianca Visciano¹, Letizia Spinelli³
(Cattedra di ¹Nefrologia e ²Cardiologia, Università degli Studi di Napoli Federico II; ²IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri,")
Parole chiave: adpkd, ecocardiogramma
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