Department of Ultrasound Medicine, The Second Affiliated Hospital of Hainan Medical University, Haikou, China,
Department of Clinical Lab, The Second Affiliated Hospital of Hainan Medical University, Haikou, China.
Cardiorenal Med. 2023;13(1):248-258. doi: 10.1159/000531711. Epub 2023 Aug 16.
Although maintenance hemodialysis (MHD) in end-stage renal disease (ESRD) appears to induce some risk factors and strengthen cardiac function, the morbidity of ESRD patients receiving hemodialysis remains high. This study aimed to identify left ventricular (LV) structural and functional abnormalities in ESRD patients on MHD using three-dimensional speckle-tracking imaging (3D-STI).
Eighty-five ESRD patients with normal LV ejection fraction (LVEF >50%) participated in this study, including 55 MHD patients comprising the chronic kidney disease (CKD) V-D group and 30 nondialysis patients comprising the CKD V-ND group. Thirty age- and sex-matched control participants who had normal kidney function were enrolled as the N group. Conventional echocardiography and 3D-STI were conducted, and global longitudinal strain (GLS), global circumferential strain (GCS), global area strain (GAS), and global radial strain (GRS) values were measured.
No substantial differences in two-dimensional LVEF were observed among the three groups, and LV hypertrophy was the most common abnormality in patients with ESRD, irrespective of whether they had received or not received MHD. There were no significant differences in the 3D LV mass index between the CKD V-ND and N groups (p > 0.05). Conversely, the 3D LV mass index was considerably higher in the CKD V-D group than in both the N and CKD V-ND groups. The GLS, GAS, and GRS values were significantly lower in the CKD V-ND group than in the N group (p < 0.05). Furthermore, the CKD V-D group had significantly lower GLS, GCS, GAS, and GRS values than the N and CKD V-ND groups (p < 0.05). The interventricular septal thickness and E/e' ratio were independently associated with LV strain values in all patients with ESRD.
MHD can exacerbate LV deformation and dysfunction in ESRD patients with preserved LVEF, and 3D-STI can be potentially useful for detecting these asymptomatic preclinical abnormalities.
尽管终末期肾病（ESRD）患者进行维持性血液透析（MHD）似乎会引发一些危险因素并增强心脏功能，但接受血液透析的 ESRD 患者的发病率仍然很高。本研究旨在使用三维斑点追踪成像（3D-STI）来确定 MHD 治疗的 ESRD 患者的左心室（LV）结构和功能异常。
本研究纳入了 85 名 LV 射血分数（LVEF >50%）正常的 ESRD 患者，包括 55 名 MHD 患者（慢性肾脏病（CKD）V-D 组）和 30 名非透析患者（CKD V-ND 组）。30 名年龄和性别匹配的肾功能正常的对照组被纳入 N 组。进行了常规超声心动图和 3D-STI 检查，并测量了整体纵向应变（GLS）、整体周向应变（GCS）、整体面积应变（GAS）和整体径向应变（GRS）值。
三组间二维 LVEF 无显著差异，LV 肥厚是 ESRD 患者最常见的异常，无论是否接受 MHD 治疗。CKD V-ND 组与 N 组间的 3D LV 质量指数无显著差异（p >0.05）。相反，CKD V-D 组的 3D LV 质量指数明显高于 N 组和 CKD V-ND 组。CKD V-ND 组的 GLS、GAS 和 GRS 值明显低于 N 组（p <0.05）。此外，CKD V-D 组的 GLS、GCS、GAS 和 GRS 值明显低于 N 组和 CKD V-ND 组（p <0.05）。所有 ESRD 患者的室间隔厚度和 E/e' 比值与 LV 应变值独立相关。
MHD 可加重 LVEF 正常的 ESRD 患者的 LV 变形和功能障碍，3D-STI 可能有助于检测这些无症状的临床前异常。
