Assessment of the Prognostic Value of MRI Left Ventricular Global Function Index (LVGFI) in Patients With End‐Stage Renal Disease Under Maintenance Dialysis

Abstract

BackgroundLeft ventricular global function index (LVGFI) integrates LV volumetric and functional parameters. In patients with end‐stage renal disease (ESRD), cardiac injury manifests as LV hypertrophy and dysfunction. However, the prognostic value of LVGFI in this population remains unclear.PurposeTo investigate the association of LVGFI with major adverse cardiac events (MACE) in patients with ESRD.Study TypeProspective.PopulationOne hundred fifty‐eight ESRD patients (mean age: 54.1 ± 14.4 years; 105 male) on maintenance dialysis.Filed Strength/Sequence3.0 T, balanced steady‐state free precession (bSSFP) cine and modified Look‐Locker inversion recovery (MOLLI) sequences.AssessmentLV volumetric and functional parameters were determined from bSSFP images. LVGFI was calculated as the ratio of stroke volume to global volume and native T1 was determined from MOLLI T1 maps. MACE was recorded on follow up. Models were developed to predict MACE from conventional risk factors combined with LVGFI, GLS, native T1, and LV mass index (LVMI), respectively. Subgroup analyses were further performed in participants with LVEF above median.Statistical TestsCox proportional hazard regression and log‐rank test were used to investigate the association between LVGFI and MACE. The predictive models were evaluated and compared using Harrell's C‐statistics and DeLong tests. A P value <0.05 was considered statistically significant.ResultsThirty‐four MACE occurred during the median follow‐up period of 26 months. The hazard of MACE increased by 114% for each 10% decrease in LVGFI in univariable analysis. The predictive model consisting of LVGFI (C‐statistic: 0.724) had significantly better predictive performance than the others (all P < 0.001). These results were consistent in patients (N = 79) with LVEF > median (63.54%).Data ConclusionLVGFI is a novel marker for MACE risk stratification in patients with ESRD and was better able to predict MACE than native T1 mapping and GLS.Evidence Level2Technical EfficacyStage 3