Left ventricular myocardial strain and septal thickness as markers of apical sparing in end-stage renal disease
O Ahmad, H Muhammad, Z Rahman, M H Omer, H Alarfaj, D Broering, Y Shah, D MohtyAbstract
Background
Left ventricular relative apical sparing pattern (RELAPS) on echocardiographic strain imaging is classically associated with cardiac amyloidosis, but evidence has shown it's prevalent in end-stage renal disease (ESRD). We aimed to evaluate the prevalence and predictors of RELAPS in a large cohort of ESRD patients.
Methods
We retrospectively screened consecutive ESRD patients who underwent transthoracic echocardiography as part of pre-transplant workup from 2020 to 2024. Patients diagnosed with transthyretin or light-chain amyloidosis were excluded. RELAPS was defined as an average apical-to-(basal+mid) longitudinal strain ratio >1.0. ESRD was defined by a glomerular filtration rate (GFR) of less than 15 mL/min/1.73 m².
Results
Among 692 ESRD patients (mean age 47.2 ± 13.5 years, 75% male), RELAPS was present in 63 (9.1%). Mean overall ejection fraction was 55 ± 7%, absolute global longitudinal strain (GLS) was 15.88 ± 2.97% and interventricular septal thickness (IVSd) was 10.27±2.25 mm. Compared to patients without RELAPS, patients with RELAPS had lower absolute GLS (13.41±3.37 vs 16.13±2.81; p <0.001) and higher IVSd (12.10±2.03 vs 10.09±2.19; p <0.001). In logistic models, a higher absolute GLS predicted lower odds of RELAPS (OR 0.76 per 1% increase, 95%CI 0.70–0.83), while increased IVSd predicted higher odds (OR 1.45 per 1 mm increase, 95%CI 1.29–1.63).
Conclusion
In ESRD patients, RELAPS was associated with impaired left ventricular GLS and increased septal thickness. These findings highlight that RELAPS is not specific to cardiac amyloidosis and may reflect broader myocardial remodeling in ESRD.RELAPSFor image description, please refer to the figure legend and surrounding text.