Abnormal Cardiac Strain Common in most CKD patients Despite Preserved LVEF, suggests study

These findings are published in December 2025 in the Indian Heart Journal.

The Clinical Burden of Silent Ventricular Dysfunction

Chronic kidney disease is globally pervasive, carrying a substantially elevated cardiovascular risk and mortality rate. While left ventricular ejection fraction (LVEF) is routinely evaluated to monitor heart health, it lacks the sensitivity required to identify early, subclinical myocardial deterioration. Global longitudinal strain (GLS) has emerged as a highly sensitive, superior alternative for detecting hidden systolic impairment. Acknowledging this diagnostic gap, researchers aimed to determine the prevalence of early left ventricular systolic dysfunction using GLS in a regional Indian CKD population, alongside its biochemical correlations and its impact on one-year mortality.

Study Overview

The single-center, prospective observational cohort study evaluated 100 adult CKD patients across varying stages of the disease, with the majority in stages 4 and 5. The analysis utilized two-dimensional speckle-tracking echocardiography to accurately calculate GLS. The research explicitly excluded individuals with an LVEF below 50%, pre-existing valvular heart disease, atrial fibrillation, or prior myocardial infarction. Following thorough clinical and echocardiographic evaluations, subjects were monitored over a one-year period to assess all-cause mortality and its correlation with myocardial strain.

The Key findings from the study include:

• Among the 100 evaluated participants, the prevalence of abnormal myocardial strain (GLS > -16%) was remarkably high at 98%, with a mean strain value of -11.01%.

• The patient cohort was predominantly male (66%), with the largest single group experiencing end-stage renal disease (47%).

• Patients exhibiting more severe ventricular impairment (GLS ≥ -11%) demonstrated a higher prevalence of concurrent comorbidities, specifically diabetes and hypertension.

• The use of vital cardioprotective medications was strikingly low; only 28% of patients were prescribed ACE inhibitors or ARBs, which investigators suggest may contribute to the uniquely high rates of abnormal strain. Conversely, statin utilization was significantly more common in those with worse strain scores.

• At the one-year follow-up, the all-cause mortality rate was 22%; however, no statistically significant link was observed between the mortality rate and the degree of GLS impairment.

Clinical Relevance and Targeted Prevention

For practicing physicians, the study highlights that subclinical left ventricular systolic dysfunction is nearly ubiquitous among CKD patients, even when standard LVEF measurements appear completely normal. The strikingly high 98% prevalence rate underscores the critical need for routine global longitudinal strain assessments to unmask silent cardiac impairment early in the disease process. Furthermore, the notably low prescription rate (28%) of standard nephroprotective and cardioprotective agents like ACE inhibitors and ARBs points to a significant therapeutic gap. Overall, integrating advanced echocardiographic screening and aggressively optimizing guideline-directed medical therapies remain essential steps for improving cardiovascular outcomes in the CKD population. While constrained by a small sample size and single-center design, these insights warrant expanded clinical vigilance.

Reference

Kumar M, Singh S, Rathore VS, Naik SK, Kumar A, Thakur CP, Varshney A. Prevalence of left ventricular systolic dysfunction measured by Global longitudinal strain echocardiography in chronic kidney disease patients with preserved left ventricular ejection fraction. Indian Heart Journal. 2025 Dec.