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Purpose:Chronickidney disease (CKD) associates with adverse cardiovascular outcomes. Using conventional echocardiographic measures there is conflicting evidence regarding the increased prevalence of diastolic dysfunction (DD) in such patients. Left ventricular (LV) torsion has been showed to be raised in early DD in diabetic patients. The objective of this study was to investigate the relation of segmental relaxation patterns and torsion with DD in CKD patients. Simultaneous assessment of arterial stiffness was performed using Pulse Wave Velocity (PWV).Methods:Thirty consecutive patients with CKD were assessed using conventional (2D and Doppler) and 2D speckle tracking echocardiography. Global DD (trasmitral inflow E/A wave ratio, E wave deceleration time (DT), mitral annulus tissue Doppler velocity recordings, regional DD (early and late diastolic strain rate parameters [SRE and SRA] of basal, mid, and apical segments of each LV wall in the longitudinal direction) and LV torsion were assessed in 25 patients who fulfilled the inclusion criteria (normal ejection fraction, no regional wall motion abnormalities).Results: The mean age of the study population was 55±15 years and the mean biplane systolic ejection fraction was 63.4%±6.5. There were 8 CKD stage 2, 8 CKD stage 3, 7 CKD stage 4 and 2 CKD stage 5 patients. Using conventional echocardiographic criteria 7 patients (26.9%) had nomal diastolic function, 11 (42.3%) had type 1 DD and 7 (26.9%) type 2 DD. Glomerular filtration rate associated significantly with the number of segments with abnormal relaxation (rho=-0.429, p=0.032), LV torsion (r=-0.581, p=0.004), LV torsion rate (r=-0.566, p=0.005) and PWV (-0.578, p=0.002). There was no significant association with E/A ratio, E/E' ratio, isovolumic relaxation time or DT. LV torsion (beta=-1.87, p=0.002) and LV torsion rate (beta-0.28, p=0.005) remained significantly associated with eGRF after adjustment for total cholesterol, diabetes, body mass index and smoking habit. Interestingly, three (42.9%) patients with normal diastolic function (using conventional criteria) had >6 segments with abnormal relaxation.Conclusions: LVsegmental relaxation demonstrates progressive deterioration in CKD whereas torsion appears to increase, compensating for the impaired diastolic filling. These markers could be used in the future to depict patients with early DD that would have been missed by applying conventional echocardiographic parameters.