Han Zhengyang, Wang Lingyun, Wang Honghu, He Hongying, Song Yi, Wang Menghe, Zhao Na, Chen Zhengguang, Sun Zhenxing, Zhang Shan
Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan, China.
Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Front Cardiovasc Med. 2024 Jul 25;11:1370307. doi: 10.3389/fcvm.2024.1370307. eCollection 2024.
Kidney transplantation (KT) has the potential to reverse the cardiac changes caused by end-stage renal disease, and it may be inaccurate to analysis the left ventricular function by conventional echocardiography due to afterload. This study aimed to investigate the utility of pressure strain loops (PSLs) in evaluating left ventricular performance in patients underwent KT.
We enrolled 60 patients with end-stage renal disease who underwent KT between January 2022 and July 2023, and 60 healthy controls with a similar distribution of gender and age to the patients. All participants underwent conventional echocardiography and three-dimensional speckle tracking echocardiography (3D-STE). Long axis, short axis, and four cavity images were collected and cardiac parameters were measured. The echocardiographic changes of cardiac structure and function of all patients before KT and about 12 months after KT were recorded. Left ventricular myocardial work parameters were acquired by PSLs, including the global work index (GWI), global constructive work (GCW), global wasted work (GWW), global work efficiency (GWE) and global longitudinal strain (GLS). In addition, the correlation between PSLs and clinical data were explored.
Compared with controls, the conventional echocardiographic parameters, myocardial function indicators GWI and GCW appeared no difference in post-KT group, while the GWE and GLS decreased (< 0.05), and the GWW increased (< 0.05). Compared with pre-KT, the GLS, GWI, GCW and GWE increased in post-KT group, while the GWW decreased (all < 0.05). The above indicators were correlated with left ventricular GLS and left ventricular ejection fraction.
PSLs were more sensitive than traditional echocardiographic indicators in detecting changes in myocardial work and predicting left ventricular myocardial damage. This indicator could quantitatively evaluate myocardial work and provide a new and reliable non-invasive reference for clinical diagnosis and treatment of patients underwent KT.
肾移植（KT）有可能逆转终末期肾病引起的心脏变化，由于后负荷的存在，采用传统超声心动图分析左心室功能可能不准确。本研究旨在探讨压力应变环（PSLs）在评估接受KT患者左心室功能中的应用价值。
我们纳入了2022年1月至2023年7月期间接受KT的60例终末期肾病患者，以及60例性别和年龄分布与患者相似的健康对照者。所有参与者均接受了传统超声心动图和三维斑点追踪超声心动图（3D-STE）检查。采集长轴、短轴和四腔图像并测量心脏参数。记录所有患者在KT前及KT后约12个月时心脏结构和功能的超声心动图变化。通过PSLs获取左心室心肌做功参数，包括整体做功指数（GWI）、整体建设性做功（GCW）、整体浪费做功（GWW）、整体做功效率（GWE）和整体纵向应变（GLS）。此外，还探讨了PSLs与临床数据之间的相关性。
与对照组相比，KT后组的传统超声心动图参数、心肌功能指标GWI和GCW无差异，而GWE和GLS降低（<0.05），GWW升高（<0.05）。与KT前相比，KT后组的GLS、GWI、GCW和GWE升高，而GWW降低（均<0.05）。上述指标与左心室GLS和左心室射血分数相关。
PSLs在检测心肌做功变化和预测左心室心肌损伤方面比传统超声心动图指标更敏感。该指标可定量评估心肌做功，为接受KT患者的临床诊断和治疗提供一种新的、可靠的无创参考。
