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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 4, July/August 2018
AFRICA
235
reduction in global longitudinal strain.
22
This compensatory increase in twist present in the CKD
patient was documented in a study by Panoulas
et al
.
19
This
study demonstrated that twist increases while longitudinal
strain decreases in CKD patients with preserved EF. This is
postulated to represent an adaptive mechanism to preserve
EF in the face of declining longitudinal myocardial function.
The increase in twist was inversely related to worsening GFR
in patients with preserved EF.
19
By contrast, our study, which
only included very late-stage CKD patients, showed significant
decrease in the apical myocardial rotation with no difference in
net twist found in haemodialysis patients compared to controls.
This is despite there being no difference in baseline EF between
the dialysis patients and controls, implying that diminution of
apical rotation and a normal LV twist as opposed to an expected
increase in twist may be an early indicator of further myocardial
dysfunction and loss of compensatory mechanisms aimed to
preserve EF (Fig. 4).
The limitations of this study are that it was a pilot study using
a single vendor (Philips Healthcare). The small sample size was
due to the size of the haemodialysis patient population at our
institution. This did not allow adequate numbers to perform
multiple linear regression analysis. The homogenous nature of
our study population may not translate to other patient cohorts.
It would be useful in larger studies to determine how twist
is affected in CKD patients with and without hypertension.
Multicentre studies with longitudinal follow up may confirm the
findings of this study.
Conclusion
LV twist and its derived rotational parameters did not change
significantly post-dialysis compared to pre-dialysis. This may
suggest that these parameters are less affected by varying loading
conditions post-dialysis. The decrease in apical rotation observed
in late-stage CKD patients compared to controls may represent
an early marker of loss of rotational compensation, which
preserves EF in the CKD patient
This study was supported by unrestricted research grants by Medtronic Ltd,
Servier Ltd and Novartis AG.
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Fig 4.
Myocardial fibre orientation and direction. Left-handed
helical orientation of the sub-endocardium. Right-
handed helical arrangement of the sub-epicardium.