Evaluation of left ventricular diastolic function based on flow energetic parameters in chronic kidney disease with diastolic dysfunction

Background: Intra-ventricular blood flow dynamics is considered as an important component of left ventricular (LV) function assessment. The purpose of this study was to evaluate the LV diastolic function in chronic kidney disease (CKD) with different degrees of LV diastolic dysfunction (LVDD) by using flow energetic parameters.

Methods: In this study, a total of 96 cases were recruited, including 58 CKD patients and 38 healthy controls. CKD patients were divided into 2 groups according to LVDD severity, named as DD1 and DD2. Vector flow-mapping (VFM) analysis was executed to calculate left ventricle average energy loss (EL) during early filling phase (E-EL_ave), atrial filling phase (A-EL_ave), diastole phase (D-EL_ave), and ejection phase (S-EL_ave). Moreover, the average vortex circulation during early filling phase (E-cir_ave) and atrial filling phase (A-cir_ave) was also assessed in the apical three-chamber view. The rate of average EL during early filling and atrial filling was expressed as E/A-EL.

Result: Compared to the control group, A-EL_ave, S-EL_ave, and A-cir_ave in the DD1 group were higher (P < 0.05), and all parameters were obviously higher in the DD2 group (P < 0.05). In the control group and the DD2 subgroup, the E-EL_ave value was significantly higher than A-EL_ave value, which was opposite to the DD1 group. As diastolic dysfunction worsened, E-EL_ave and D-EL_ave risen gradually (P < 0.05), and A-EL_ave and S-EL_ave were slightly elevated with no significance. There were significant correlations between LV diastolic function and flow energetic parameters. Stepwise multiple regression analysis revealed that various LV function parameters could be regarded as independent predictors of average diastolic EL (all P < 0.01).

Conclusions: For CKD patient with LVDD and LVEF > 50%, effective LV filling and systolic ejection with optimized energy consumption have been impaired. As a new flow-derived index, EL can quantitatively evaluate LV diastolic function in terms of blood fluid dynamics in CKD with various LVDD.