Correlation between cardiac remodeling and functional impairment assessed by cardiac magnetic resonance with feature tracking in patients with end-stage renal disease

Background: End stage renal disease patients are prone to cardiac structural and functional changes, known as

“cardiomyopathy of advanced CKD” ,which are associated to cardiovascular outcomes. The early detection of these changes is a prognostic challenge.
We aimed to assess the correlation between structural cardiac remodeling and functional impairment using cardiac magnetic resonance (CMR) with feature tracking (CMR-FT).

Methods: We conducted a retrospective analysis of 845 asymptomatic ESRD patients who underwent stress CMR between July 2008 and June 2022. CMR was performed using a standardized protocol to evaluate left ventricular (LV) and left atrial (LA) structure and function. LV and LA strains were assessed using CMR-FT. In addition to strain analysis, other parameters such as LV ejection fraction (LVEF), LV mass, and LA volume were measured. Patients were categorized into four groups based on LV morphology:

normal morphology, LV hypertrophy (LVH) with normal geometry, concentric remodeling and concentric hypertrophy.

The correlation between cardiac remodeling and both LV and LA strain impairments was analyzed.

Results: The distribution of patients in the four groups was as follows: 30% with normal morphology, 35% with LV hypertrophy and normal geometry, 12% with concentric remodeling, and 23% with concentric hypertrophy. A significant correlation was found between abnormal LV morphology and impaired LV and LA function, and patients with



concentric hypertrophy

had the most pronounced reductions in both LV and LA strains (respectively

-11.4%

and 22.5%, vs -16% and 37.3% for normal morphology group, -13.5%and 27.1% for normal geometry with LVH, -13.1% and 29.3% for concentric remodeling, p< 0.001).

Furthermore, low LV strain was observed in 40% of patients with preserved LVEF ( >50%), 93% of those with moderately reduced LVEF (35–50%), and all of those with severely reduced LVEF (< 35%), suggesting that strain impairment precedes LVEF decline in end-stage renal disease.

Conclusion: Our findings showed that cardiac remodeling is prevalent in ESRD patients, with significant implications for both LV and LA function as assessed by LV and LA strain. This study highlights strain analysis as a key tool for detecting early myocardial dysfunction, even in those with normal cardiac morphology and normal LV function.

Proportion of patients with LV and LA strain impairment by groups with post-hoc analysis between groups.
Distribution of low LV Strain across LVEF categories.
Proportion of patients with LV and LA strain impairment by groups with post-hoc analysis between groups.
Distribution of low LV Strain across LVEF categories.