Global longitudinal strain correlates poorly with mortality in people with diabetes mellitus and receiving haemodialysis

Introduction: Haemodialysis (HD) is a life-sustaining treatment for individuals with end-stage kidney disease (ESKD). However, the risk of mortality remains significantly higher compared to the general population, even when matched for age and sex. Global longitudinal strain (GLS), derived from speckle tracking echocardiography, has shown promise as a predictor of mortality in HD patients. However, its prognostic utility in patients with multiple cardiovascular risk factors such as diabetes mellitus (DM) and receiving HD, remains unclear. This study aimed to evaluate the prognostic value of GLS in HD patients, with and without DM.

Methods: This prospective study was a long term follow up extension study of an earlier published study that investigated a cohort of haemodialysis patients from a single centre with a comprehensive cardiovascular imaging protocol. All patients had an echocardiography with the use of speckle-tracking software to determine GLS. Patients were divided into Group A (with DM) and Group B (without DM). Patients were followed up until death, major adverse cardiovascular events (MACE), transplantation or the censoring date (29 February 2024). Statistical analyses were performed using univariate Cox proportional hazards models.

Results: A total of 184 patients receiving HD were included in the analysis. Patients with DM (Group A) had significantly higher all-cause mortality (ACM) (47.1% vs. 20.7%, P<0.001) and a lower chance of receiving a kidney transplant (13.2% vs. 43.1%, P<0.001). In Group A, GLS did not predict ACM, whereas in Group B, a GLS cutoff of -15.76% correlated with higher 5-year ACM (P=0.036). Left ventricular ejection fraction (LVEF) was a significant predictor of ACM in Group A (HR 0.98; P=0.036).

Conclusion: GLS is a poor predictor of adverse outcomes in HD patients with DM, likely due to their high cardiovascular risk. In contrast, GLS was a significant predictor of mortality in non-diabetic HD patients. LVEF may be a more reliable prognostic indicator in high-risk diabetic patients.