Abstract: Objective  To explore the predictive value of three-dimensional speckle tracking imaging (3D-STI) combined with red blood cell distribution width (RDW) for major adverse cardiovascular events (MACE) in hemodialysis (HD) patients.  Methods  This is a retrospective cohort study, which includes 350 HD patients admitted to the 942nd Hospital of the Joint Logistics Support Force of Chinese PLA from January 2023 to June 2024. Patients were followed for 6 months and divided into MACE group (n=117) and non-MACE group (n=233) based on the presence or absence of MACE. Clinical data, conventional echocardiographic parameters, and 3D-STI parameters, which include global area strain (GAS), global circumferential strain (GCS), global longitudinal strain (GLS), global radial strain (GRS) and three-dimensional left ventricular ejection fraction (3D-LVEF), were collected, and RDW was measured using a fully automated hematology analyzer. Risk factors for MACE were analyzed, and receiver operating characteristic (ROC) curve was used to evaluate the predictive value of 3D-STI combined with RDW for MACE in HD patients.  Results  During the 6-month follow-up, the incidence of MACE was 33.43% (117/350). Compared with the non-MACE group, the MACE group had higher age, higher levels of left atrial diameter (LAD), GAS, GCS, GLS, RDW, low-density lipoprotein cholesterol (LDL-C) and intact parathyroid hormone (iPTH), and longer dialysis vintage, but lower GRS and 3D-LVEF (t/Z=3.752, 2.906, 5.322, 5.499, 3.756, 9.609, 5.271, 5.967, 4.835, 5.922 and 5.288 respectively; all P＜0.001). Multivariate logistic regression identified dialysis vintage (OR=1.042, 95% CI: 1.023～1.062, P＜0.001), LDL-C (OR=1.281, 95% CI: 1.154～1.422, P＜0.001), iPTH (OR=1.002, 95% CI: 1.001～1.004, P＜0.001), GAS (OR=1.129, 95% CI: 1.051～1.214, P=0.001), GCS (OR=1.217, 95% CI: 1.107～1.339, P＜0.001), GLS (OR=1.137, 95% CI: 1.034～1.250, P=0.008), and RDW (OR=2.522, 95% CI: 1.832～3.473, P＜0.001) as the independent risk factors for MACE, while GRS (OR=0.965, 95% CI: 0.938～0.992, P=0.012) and 3D-LVEF (OR=0.922, 95% CI:0.878～0.968, P=0.001) as the independent protective factors for MACE. The area under ROC curve (AUC) for predicting MACE using 3D-STI parameters (including GAS, GCS, GLS, GRS and 3D-LVEF) combined with RDW was 0.887, higher than that using 3D-STI parameters (0.821) or RDW (0.770) alone (Z=3.876 and 5.319, P＜0.001).  Conclusion  3D-STI parameters (GAS, GCS, GLS, GRS and 3D-LVEF) and RDW are independently associated with MACE in HD patients. 3D-STI parameters combined with RDW has higher predictive value for MACE in HD patients.

Key words: Hemodialysis, Three-dimensional speckle tracking imaging, Red blood cell distribution width, Major adverse cardiovascular events