Connection between Cardiac Fibrosis Biomarkers and Echocardiography Parameters in Advanced Chronic Kidney Disease Patients

Background: Myocardial fibrosis represents a mainstay pathway in the pathophysiology of uremic cardiomyopathy. This process leads to structural and functional changes in the heart, which can be detected by echocardiography. The purpose of our study was to determine the association between four echocardiographic parameters (ejection fraction (EF), global longitudinal strain (GLS), mean E/e' ratio, and left atrial volume indexed) and biomarkers associated with cardiac fibrosis, such as procollagen type I carboxy-terminal propeptide (PICP), procollagen type III N-terminal peptide (P3NP), and galectin-3 (Gal-3) in patients with end-stage renal disease (ESRD). Methods: 140 patients with ESRD were enrolled and investigated by echocardiography and the serum levels of the aforementioned biomarkers were determined at baseline. Results: The mean EF was 53.63 +/- 8%, the mean GLS was -10.2 +/- 5.3%, the mean E/e' ratio was 9.8 +/- 4.3, and the mean left atrial volume indexed (LAVI) was 45.8 +/- 14.2 mL/m(2). The average levels for PICP, P3NP, and Gal-3 were 457.2 +/- 240 mu g/L, 242 +/- 199.9 mu g/L, and 10.7 +/- 3.7 ng/mL, respectively. In regression analysis, PICP was strongly associated with all four echocardiographic parameters (EF: p = 0.0002, R-2 = 0.69; GLS: p = 0.00001, R-2 = 0.81; mean E/e': p = 0.00002; R-2 = 0.89; LAVI: p = 0.003; R-2 = 0.73). P3NP and Gal-3 were only associated with the EF (p = 0.01, R-2 = 0.31 and p = 0.02; R-2 = 0.35, respectively). Conclusion: Our study evidenced that PICP, a collagen-derived biomarker, is associated with important echocardiography parameters, suggesting that it can serve as an indicator of the presence of subclinical systolic and diastolic dysfunction in patients with advanced CKD.

Automated summary

This study aimed to determine the association between echocardiographic parameters and biomarkers of cardiac fibrosis in patients with end-stage renal disease. The results showed a significant correlation between echocardiographic parameters and biomarkers, especially a strong association between the collagen-derived biomarker PICP and cardiac function indicators.