Prognostic value of left ventricular peak strain dispersion for cardiovascular events in patients undergoing maintenance haemodialysis: a single-center retrospective cohort study with propensity score matching
Abstract This study evaluates the association between baseline left ventricular (LV) peak strain dispersion (PSD) and 3-to-5-year cardiovascular outcomes in patients undergoing maintenance hemodialysis (MHD). This single-center retrospective cohort study screened 586 adult patients undergoing MHD at a tertiary renal unit between January 2018 and December 2020, with follow-up through June 2024. Patients were stratified by baseline PSD at the prespecified cutoff of ≥65 ms. One-to-one propensity score matching (nearest neighbor, caliper: 0.02) using 24 covariates was applied to minimize confounding. The primary outcome was major adverse cardiovascular events (MACE)—a composite of cardiovascular death, nonfatal myocardial infarction, hospitalization for heart failure, nonfatal stroke and sustained ventricular arrhythmia. Secondary outcomes included cardiovascular and all-cause mortality. Survival was analyzed using Kaplan–Meier curves, matched-pair robust Cox proportional hazards models and competing-risk sensitivity analyses. After matching, 336 patients (168 per group) were analyzed, with excellent covariate balance (all standardized mean differences <0.10). Over a median follow-up of 46.8 months, MACE occurred in 64 patients (38.1%) with high PSD and 34 patients (20.2%) with low PSD. High PSD was associated with a higher hazard of MACE (adjusted hazard ratio [aHR]: 2.05, 95% confidence interval [CI]: 1.48–2.84; p < 0.001), cardiovascular mortality (aHR: 2.18, 95% CI: 1.08–4.40; p = 0.030) and all-cause mortality (aHR: 1.58, 95% CI: 1.02–2.45; p = 0.041). Subgroup analyses demonstrated directionally consistent associations, with a stronger association in patients with impaired global longitudinal strain (interaction p = 0.03). Baseline LV PSD was associated with adverse cardiovascular outcomes in patients receiving MHD. Incorporating PSD into echocardiographic risk stratification may refine risk assessment, but multicenter prospective validation is required before threshold-based clinical implementation.