Global longitudinal strain is superior to ejection fraction for detecting myocardial dysfunction in end-stage renal disease with hyperparathyroidism

Table 1 Demographic and clinical variables in the study groups

Demographic variables	Control, n = 15	ESRD-HD, n = 15	ESRD-PD, n = 15	Total, n = 15
Age (yr)	34 ± 13	36 ± 2	34 ± 10	34.6 ±
Gender, n (%)	F = 10 (67), M = 5 (33)	F = 26 (84), M = 5 (16)	F = 12 (39), M = 19 (61)	F = 48 (62), M = 29 (38)
BMI (kg/m2 )	23.4	23.3	22.4	23 ±
Hypertension, n (%)	N/A	28 (90)	31 (100)	59 (77)
DMT2, n (%)	N/A	2 (6.45)	5 (16)	7 (9.09)

ESRD: End-stage renal disease; ESRD-HD: ESRD on hemodialysis; ESRD-PD: ESRD on peritoneal dialysis; F: Female; M: Male; BMI: Body mass index; N/A: Not available.

Table 2 Biochemical and left ventricular remodeling variables in the study groups: Control, end-stage renal disease on hemodialysis and end-stage renal disease on peritoneal dialysis

Variables	Control	ESRD-HD	ESRD-PD	P value
Biochemical
PTH (pg/mL)	50 ± 4.55a,c	1188 ± 203.9	1188 ± 203.9	< 0.0001
Ca2+ (mg/dL)	8.55 ± 2.34	8.47 ± 0.14	8.38 ± 0.09	NS
P (mg/dL)	4.56 ± 2.28	4.75 ± 0.24	4.75 ± 0.28	NS
Ca2+/P (mg2/dL2)	45.32 ± 1.05	42.31 ± 2.35	39.87 ± 2.5	NS
Albumin (mg/dL)	4.47 ± 0.10a,c	4.13 ± 0.12	3.94 ± 0.06	< 0.0284
Hemoglobin (g/dL)	15.3 ± 0.12a,c	8.73 ± 0.24	8.91 ± 0.22	< 0.0001
LV remodeling
LV mass (g)	133.8 ± 3a,c	182.7 ± 12.2	186.6 ± 15	< 0.0001
LVMI (g/m2)	70.65 ± 2.11a,c	130.2 ± 6.24	127.5 ± 6.55	< 0.0001
RWT	0.39 ± 0.016a,c	0.51 ± 0.01	0.51 ± 0.02	< 0.0001

^aP < 0.05, control vs ESRD-HD.

^cP < 0.05, control vs ESRD-PD.

The data represent the mean SD. ANOVA followed by a Tukey test was performed and was considered significant. ESRD: End-stage renal disease; ESRD-HD: ESRD on hemodialysis; ESRD-PD: ESRD on peritoneal dialysis; PTH: Plasma parathyroid hormone; LV: Left ventricular; LVMI: LV mass index; NS: Not significant.

Table 3 Echocardiographic population variables control, end-stage renal disease on hemodialysis and end-stage renal disease on peritoneal dialysis

Variables	Control	ESRD-HD	ESRD-PD	P value
LVEF	60.75 ± 1.30	63.5 ± 10.36	61.8 ± 11.19	NS
GLS (%)	21 ± 0.58a,c	13 ± 0.72	12 ± 1.83	< 0.0001
LAV (mL/m2)	33.07 ± 0.22a,c	26.49 ± 1.4	25.73 ± 1.57	< 0.0001
E/A ratio	1.25 ± 0.03a,c	1.05 ± 0.06	0.91 ± 0.05	< 0.0001
E/é ratio	5.38 ± 0.18a,c	11.62 ± 0.96	12.22 ± 1.13	< 0.0001
E (cm/s)	60.39 ± 1.71a,c	80.19 ± 6.26	81.29 ± 6.97	< 0.0001
Lateral e’ (cm/s)	13.44 ± 0.36a,c	8.33 ± 0.43	7.49 ± 0.16	< 0.0001
Septal é (cm/s)	10.85 ± 0.35a,c	6.18 ± 0.24	6.49 ± 0.23	< 0.0001
TRV (m/s)	2.21 ± 0.02a,c	2.94 ± 0.08	2.80 ± 0.07	< 0.0001
LVMI (g /m2)	70.65 ± 2.11a,c	130.2 ± 6.24	127.5 ± 6.55	< 0.0001
RWT	0.39 ± 0.016a,c	0.51 ± 0.01	0.51 ± 0.02	< 0.0001

^aP < 0.05, control vs ESRD-HD.

^cP < 0.05, control vs ESRD-PD.

The data represents mean SD. ANOVA followed by Tukey test was performed and was considered significant. ESRD: End-stage renal disease; ESRD-HD: ESRD on hemodialysis; ESRD-PD: ESRD on peritoneal dialysis; LVEF: Left ventricular ejection fraction; GLS: Global longitudinal strain; LAV: Left atrial volume; TRV: Tricuspid regurgitation velocity; LVMI: LV mass index; NS: Not significant; RWT: Relative wall thickness.

Table 4 Global longitudinal strain and variables association

Variables	Univariate					Multivariate using significant variables					Multivariate by step method
	B	β	95%CI for B		P value	B	β	95%CI for B		P value	B	β	95%CI for B		P value
			Lower limit	Upper limit				Lower limit	Upper limit				Lower limit	Upperlimit
Association with GLS (%)
Hemoglobin	-1.09	-0.61	-1.42	-0.77	0.00	-0.58	-0.32	-1.12	-0.05	0.03	-0.62	-0.35	-0.99	-0.26	0.00
Hypertension	5.60	0.54	3.58	7.61	0.00	1.52	0.15	-1.44	4.49	0.31
PTH	0.00	0.50	0.00	0.00	0.00	0.00	0.27	0.00	0.00	0.01	0.00	0.29	0.00	0.00	0.00
LVEF	-0.04	-0.08	-0.15	0.07	0.50
LVH	6.40	0.57	4.27	8.53	0.00	-1.82	-0.16	-7.75	4.12	0.54
LVMI	0.06	0.51	0.04	0.08	0.00	0.03	0.28	0.01	0.05	0.01	0.03	0.29	0.01	0.05	0.00
RWT	11.36	0.25	1.27	21.46	0.03	-1.21	-0.03	-10.14	7.73	0.79

95%CI: 95% confidence interval; GLS: Global longitudinal strain; PTH: Plasma parathormone; LVEF: Left ventricular ejection fraction; LVH: Left ventricular hypertrophy; LVMI: Left ventricular mass index; RWT: Relative wall thickness.

Table 5 Association between parathyroidism levels and left ventricular diastolic dysfunction variables

Variables	Univariate					Multivariate using significant variables					Multivariate by step method
	B	β	95%CI for B		P value	B	β	95%CI for B		P value	B	β	95%CI for B		P value
			Lower limit	Upper limit				Lower limit	Upper limit				Lower limit	Upper limit
Association with PTH
E/é ratio	54.22	0.33	18.34	90.09	0.00	28.19	0.17	-11.55	67.93	0.16
é lateral	-124.,51	-0.36	-199.34	-49.69	0.00	-81.10	-0.23	-177.06	14.87	0.10	-89.72	-0.26	-169.01	-10.44	0.03
é septal	-121.78	-0.28	-215.64	-27.91	0.01	-0.63	0.00	-121.22	119.97	0.99
TRV	698.98	0.35	276.86	1121.10	0.00	360.73	0.18	-141.53	862.99	0.16	500.88	0.25	53.87	947.89	0.03

95%CI: 95% confidence interval; PTH: Plasma parathormone; TRV: Tricuspid regurgitation velocity.