Myocardial Injury in Peritoneal Dialysis Patients Assessed by Multiparametric MRI: Relationship With Left Ventricular Phenotypes.

ABSTRACT

BACKGROUND: Myocardial injury is common in end-stage renal disease (ESRD) patients, but the presence and severity of myocardial injury in different left ventricular (LV) phenotypes were still not fully explored. PURPOSE: To evaluate myocardial tissue characteristics and deformation in ESRD patients on peritoneal dialysis separated into normal geometry, concentric remodeling, concentric left ventricular hypertrophy (LVH) and eccentric LVH patterns by multiparametric cardiac MRI. STUDY TYPE Prospective. POPULATION A total of 142 subjects, including 102 on peritoneal dialysis (69 males) and 40 healthy controls (27 males). FIELD STRENGTH/SEQUENCE At 3.0 T, cine sequence, T1 mapping and T2 mapping. ASSESSMENT LV mass index and LV remodeling index were used to create four subgroups with normal geometry, concentric remodeling, concentric LVH, and eccentric LVH. LV function, strain and strain rate, myocardial native T1 and T2 were measured. STATISTICAL TESTS Descriptive statistics, analysis of variance and analysis of covariance, Pearson/Spearman correlation, stepwise regression, and intraclass correlation coefficient. P-value <0.05 was considered statistically significant. RESULTS: Even in normal geometry, LV strain parameters still diminished compared with the controls (global radial strain 30.5 ± 7.7% vs. 37.1 ± 7.9%; global circumferential strain -18.2 ± 2.6% vs. -20.6 ± 2.2%; global longitudinal strain -13.3 ± 2.5% vs. -16.0 ± 2.8%). Eccentric LVH had significantly lower global circumferential systolic strain rate than concentric LVH (-0.82 ± 0.21%/-second vs. -0.96 ± 0.20%/-second). Compared with the controls, the four subgroups all revealed elevated native T1 and T2, especially in eccentric LVH, while concentric remodeling had the least changes including native T1, T2, and LV ejection fraction. After adjusting for covariates, there was no statistically significant difference in T2 between the four subgroups (P = 0.359). DATA CONCLUSIONS: Eccentric LVH is associated with the most pronounced evidence of myocardial tissue characteristics and function impairment, while as a benign remodeling, the concentric remodeling subgroup had the least increase in native T1. This study further confirms that native T1 and strain indicators can reflect the severity of myocardial injury in ESRD, providing better histological and functional basis for future grouping treatments. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY Stage 3.