Introduction
Materials and methods
Subjects
HD characteristics
Data collection
Parameters | Ventricular SSFP-cines | Ventricular SPAMM tagging | Aortic SSFP-cines for distensibility | Aortic velocity-encoded for PWV |
---|---|---|---|---|
Respiratory compensation | breath-hold | breath-hold | breath-hold | free breathing |
Acquisition time (s) | 12–18 | 12–18 | 12–18 | 240–360 |
ECG gating | retrospective | retrospective | retrospective | retrospective |
TR: repetition time (ms) | 3.2 | 6.7 | 3.2 | 6.7 |
TE: echo time (ms) | 1.7 | 3.1 | 1.7 | 4.5 |
Voxel size (mm) | 1.7 × 1.7 × 8 | 1.7 × 2.4 × 10 | 1.3 × 2.5 × 5 | 1.3 × 2.5 × 5 |
Slice thickness (mm) | 8 | 10 | 5 | 5 |
Interslice gap (mm) | 2 | 6–12 | NA | NA |
Typical field-of-view (mm) | 380 | 380 | 320 | 320 |
Matrix | 224 × 224 | 224 × 160 | 256 × 128 | 256 × 128 |
Parallel imaging | enabled | enabled | enabled | enabled |
View-sharing | Yes | Yes | Yes | Yes |
Flip angle (degrees) | 60 | 12 | 60 | 30 |
Number of signal averages | 1 | 1 | 1 | 4 |
Lines per segment | 16 | 10 | 16 | 1 |
Reconstructed phases | 30 | 30 | 30 | 100 |
Temporal resolution (ms) | 20–50 | 20–40 | 20–50 | <10 |
VENC (cm/s) | 150–200 |
Body composition
Biochemical markers
Data analysis
Strain analysis
Aortic distensibility
Statistical analysis
Results
HD (n = 54) | Controls (n = 29) |
p value | |
---|---|---|---|
Age (years) | 57 ± 15 | 56 ± 17 | 0.7 |
Female (%) | 15 (28) | 8 (28) | 1 |
Anthropometric variables | |||
Body mass index (kg/m2) | 28 ± 6 | 27 ± 3 | 0.5 |
Body surface area(m2) | 1.9 ± 0.2 | 1.9 ± 0.2 | 0.9 |
Medical history | |||
Time since commenced HD (days) | 94 ± 84 | ||
Diabetes mellitus (%) | 14 (26) | 2 (7) | |
Ischaemic heart disease (%) | 13 (24) | 0 (0) | |
Current/ex-smoker (%) | 25 (46) | 8 (28) | |
Peripheral vascular disease/stroke (%) | 7 (13) | 0 (0) | |
LV systolic dysfunction (%) | 4 (7) | 0 (0) | |
Medication | |||
Treated hypertension (%) | 42 (78) | 2 (7) | |
RAAS antagonist (%) | 14 (26) | 1 (3) | |
Beta blocker (%) | 19 (35) | 0 (0) | |
Other antihypertensive (%) | 37 (69) | 2 (7) | |
Statin use (%) | 23 (43) | 4 (14) | |
CMR parameters | |||
Global peak systolic strain (%) | 15.9 ± 3.7 | 19.3 ± 3.4 | <0.001 |
Basal peak systolic strain (%) | 14.5 ± 3.8 | 18.4 ± 4.5 | <0.001 |
Mid-ventricular peak systolic strain(%) | 16.2 ± 4 | 20 ± 4.2 | <0.001 |
Apical peak systolic strain (%) | 16.9 ± 4.1 | 19.7 ± 3.4 | 0.002 |
Peak diastolic strain rate (s-1) | 1.07 ± 0.33 | 1.31 ± 0.38 | 0.003 |
Peak systolic strain rate (s-1) | 1.03 ± 0.22 | 1.28 ± 0.24 | 0.006 |
LV dyssynchrony by SD-TTP (ms) | 56 ± 21 | 39 ± 14 | <0.001 |
LV end-diastolic volume index (ml/m2)* | 88 ± 23 | 75 ± 14 | 0.002 |
LV stroke volume index (ml/m2)* | 44 ± 12 | 44 ± 9 | 0.8 |
LV ejection fraction (%) | 51 ± 10 | 59 ± 5 | <0.001 |
LV mass index(g/m2)* | 63 [54, 79] | 46 [42, 53] | <0.001 |
LV mass/volume ratio (g/ml) | 0.76 [0.64, 0.86] | 0.65 [0.55, 0.71] | 0.001 |
Aortic distensibility (mmHg−1 × 10−3) | 2 [1.3, 3.1] | 4.1 [3.1, 6.2] | <0.001 |
Aortic pulse wave velocity (m/s) | 7.9 ± 3.5 | 5.3 ± 1.9 | 0.03 |
Systolic blood pressure (mmHg) | 143 ± 27 | 139 ± 18 | 0.6 |
Diastolic blood pressure (mmHg) | 76 ± 12 | 80 ± 10 | 0.2 |
Pulse pressure (mmHg) | 61 [50, 79] | 60 [48, 68] | 0.3 |
Image quality
Global systolic and diastolic function
LV mass and geometry
Regional heterogeneity of LV strain
LV segment number | LV segment name | HD | NC |
p value |
---|---|---|---|---|
1 | Basal Anterior | 13.7 ± 5.7 | 15.1 ± 5.8 | 0.3 |
2 | Basal Antero-septal | 9.6 ± 5.2 | 13.5 ± 4.8 | 0.001 |
3 | Basal Infero-septal | 11.3 ± 5.1 | 12.2 ± 4.7 | 0.4 |
4 | Basal Inferior | 14.7 ± 6.8 | 16.8 ± 5.4 | 0.2 |
5 | Basal Infero-lateral | 20.6 ± 6.8 | 24.5 ± 5.8 | 0.01 |
6 | Basal Antero-Lateral | 18.5 ± 5.6 | 22.5 ± 5.6 | 0.003 |
7 | Mid Anterior | 18.8 ± 5.6 | 21.6 ± 4.3 | 0.02 |
8 | Mid Antero-septal | 14.3 ± 5.5 | 18.0 ± 4.5 | 0.003 |
9 | Mid Infero-septal | 13.3 ± 5.2 | 18.0 ± 3.5 | <0.001 |
10 | Mid Inferior | 17.4 ± 6.4 | 20.0 ± 4.9 | 0.05 |
11 | Mid Infero-lateral | 23.3 ± 6.4 | 24.4 ± 3.5 | 0.4 |
12 | Mid Antero-Lateral | 19.3 ± 4.9 | 21.4 ± 3.8 | 0.05 |
13 | Apical Anterior | 17.5 ± 4.9 | 18.6 ± 4.2 | 0.3 |
14 | Apical Septal | 14.7 ± 5.3 | 18.0 ± 4.1 | 0.003 |
15 | Apical Inferior | 17.9 ± 6.4 | 20.4 ± 6.7 | 0.07 |
16 | Apical Lateral | 20.2 ± 5.4 | 20.7 ± 4.8 | 0.6 |
LV dyssynchrony
CMR Parameter | PSS | PDSR | SD-TTP | Aortic distensibility | ||||
---|---|---|---|---|---|---|---|---|
r-value |
p value | r-value |
p value | r-value |
p value | r-value |
p value | |
Peak diastolic strain rate | 0.56 | <0.001 | - | - | -0.51 | <0.001 | 0.3 | 0.1 |
LV dyssynchrony by SD-TTP | -0.51 | <0.001 | -0.51 | <0.001 | - | - | -0.25 | 0.2 |
LV ejection fraction | 0.54 | <0.001 | 0.34 | 0.01 | -0.45 | 0.001 | 0.22 | 0.3 |
Global peak systolic strain rate | 0.53 | <0.001 | 0.6 | <0.001 | -0.35 | 0.01 | 0.43 | 0.02 |
LV mass index | -0.19 | 0.2 | -0.1 | 0.5 | 0.18 | 0.2 | -0.24 | 0.2 |
LV end-diastolic volume Index | 0.02 | 0.9 | 0.14 | 0.3 | 0.10 | 0.5 | 0.10 | 0.6 |
LV mass/volume ratio (g/ml) | -0.37 | 0.005 | -0.30 | 0.03 | 0.19 | 0.2 | -0.42 | 0.02 |
Global peak systolic strain | - | - | 0.56 | <0.001 | -0.51 | <0.001 | 0.37 | 0.05 |
Aortic distensibility§
| 0.37 | 0.047 | 0.3 | 0.1 | -0.25 | 0.2 | - | - |
Aortic pulse wave velocity | 0.01 | 0.9 | -0.48 | 0.04 | 0.27 | 0.3 | -0.69 | 0.001 |
Biochemical markers | ||||||||
High-sensitivity troponin-T§
| -0.41 | 0.03 | -0.18 | 0.4 | 0.37 | 0.06 | -0.53 | 0.004 |
NT-Pro-BNP§
| -0.20 | 0.2 | -0.26 | 0.08 | 0.04 | 0.8 | -0.15 | 0.4 |
Demographic variables | ||||||||
Age | -0.24 | 0.08 | -0.31 | 0.02 | 0.07 | 0.6 | -0.73 | <0.001 |
Anthropometric variables | ||||||||
Body mass index | -0.12 | 0.4 | 0.05 | 0.7 | -0.08 | 0.6 | -0.09 | 0.6 |
Body surface area | -0.24 | 0.08 | 0.03 | 0.8 | 0.24 | 0.09 | -0.06 | 0.8 |
ECW/TBW§
| -0.26 | 0.1 | -0.18 | 0.3 | -0.03 | 0.8 | -0.28 | 0.2 |
Aortic distensibility
Subgroup of HD patients with normal EF
Controls with EF > 50 % (n = 29) | HD with EF > 50 % (n = 35) |
p value | |
---|---|---|---|
Age (years) | 55 ± 16 | 56 ± 17 | 0.9 |
Female (%) | 9(26%) | 8(28%) | 1 |
Anthropometric variables | |||
Body Mass Index (kg/m2) | 28 ± 6 | 27 ± 3 | 0.4 |
Body surface area (m2) | 1.9 ± 0.2 | 1.9 ± 0.2 | 0.9 |
Extracellular water/Total body water ratio | 0.39 [0.38, 0.40] | ||
Medical history | |||
Time since commenced HD (days) | 98 ± 53 | ||
Diabetes mellitus (%) | 6 (17) | 2 (7) | |
Ischaemic heart disease (%) | 9 (26) | 0 (0) | |
Current/Ex-smoker (%) | 15 (43) | 8 (28) | |
Peripheral vascular disease/Stroke (%) | 4 (11) | 0 (0) | |
LV systolic dysfunction (%) | 3 (9) | 0 (0) | |
Medication | |||
Treated hypertension (%) | 29 (83) | 2 (7) | |
RAAS antagonist (%) | 12 (34) | 1 (3) | |
Beta blocker (%) | 15 (43) | 0 (0) | |
Other antihypertensive (%) | 25 (71) | 2 (7) | |
Statin use (%) | 15 (43) | 4 (14) | |
Biochemical markers | |||
High-sensitivity troponin-T ( μg/L) | 27 [13, 54] | ||
NT-pro-BNP (pg/ml) | 143 [60, 513] | ||
CMR parameters | |||
Global peak systolic strain (%) | 17.5 ± 3.1 | 19.3 ± 3.4 | 0.03 |
Basal peak systolic strain (%) | 16.2 ± 3.4 | 18.4 ± 4.5 | 0.04 |
Mid-ventricular peak systolic strain (%) | 18.0 ± 3.4 | 20.0 ± 4.2 | 0.05 |
Apical peak systolic strain (%) | 18.2 ± 3.9 | 19.7 ± 3.4 | 0.1 |
Peak diastolic strain rate (s-1) | 1.10 [0.83, 1.31] | 1.27 [1.04, 1.41] | 0.03 |
Peak systolic strain rate (s-1) | -1.05 [-1.23, -0.89] | -1.27 [-1.40, -1.12] | <0.001 |
LV dyssynchrony by SD-TTP (ms) | 51 ± 18 | 39 ± 14 | 0.006 |
LV end-diastolic volume index (ml/m2)* | 85 ± 21 | 75 (14) | 0.04 |
LV stroke volume index (ml/m2)* | 48 ± 11 | 44 (9) | 0.2 |
LV ejection fraction (%) | 56 ± 5 | 59 (5) | 0.01 |
LV mass index(g/m2)* | 63 [55, 79] | 46 [42, 53] | <0.001 |
LV mass/volume ratio (g/ml) | 0.77 [0.68, 0.86] | 0.65 [0.55, 0.71] | <0.001 |
Aortic distensibility (mmHg−1 × 10−3) | 2.6 [1.9, 4.8] | 4.1 [3.1, 6.2] | 0.04 |
Aortic pulse wave velocity (m/s) | 7.0 ± 3.6 | 5.3 ± 1.9 | 0.2 |
Systolic blood pressure (mmHg) | 137 ± 23 | 139 ± 18 | 0.7 |
Diastolic blood pressure (mmHg) | 74 ± 14 | 80 ± 10 | 0.08 |
Pulse pressure (mmHg) | 57 [49, 76] | 60 [48, 68] | 0.8 |