Institution of Medical Imaging, Guizhou Medical University, Guiyang, Guizhou, China.
Department of Ultrasound Medicine, The First People's Hospital of Guiyang, Guiyang, Guizhou, China.
Echocardiography. 2024 Oct;41(10):e15928. doi: 10.1111/echo.15928.
Chronic kidney disease (CKD) is strongly linked to the incidence and mortality of cardiovascular diseases (CVDs), with left ventricular myocardial damage being the most prevalent. This study aimed to assess left ventricle (LV) dysfunction using three-dimensional speckle tracking imaging (3D-STI) in CKD patients.
A total of 110 CKD patients and 55 healthy volunteers underwent echocardiography. CKD patients were divided into CKD1 group and CKD2 group based on the estimated glomerular filtration rate (eGFR). Assessing cardiac function via two-dimensional speckle tracking echocardiography (2D-STE) and three-dimensional speckle tracking echocardiography (3D-STE) parameters, with strain presented in absolute terms. Collecting and comparing clinical and echocardiographic parameters from three groups, assessing 3D-STI's value in evaluating LV functional impairment in CKD patients via correlation and receiver operating characteristic (ROC) curve analyses, and identifying risk factors for CKD progression to end-stage renal disease (ESRD) through univariate and multivariate analyses.
In CKD2 group, 2D-left ventricular ejection fraction (LVEF), 3D-LVEF, 2D left ventricular global longitudinal strain (2D-LVGLS), 3D-LVGLS, and 3D-left ventricular global circumferential peak strain (LVGCS) significantly worsen compared to the control and CKD1 groups, with statistically significant distinctions between the latter two (all p < 0.05). The absolute value of 3D-LVGLS shows a robust correlation with N-terminal pro-B-type natriuretic peptide (NT-proBNP) and serum creatinine (Scr) (r = -0.598, -0.649, both p < 0.001). ROC curve analysis indicates higher diagnostic efficacy of 3D-LVGLS and 3D-LVGCS for LV systolic function than 2D-LVGLS. Univariate and multivariate analyses reveal an independent association of 3D-LVGLS with the progression to ESRD in CKD.
3D-LVGLS and 3D-LVGCS effectively detect LV dysfunction in CKD patients. Specifically, 3D-LVGLS demonstrates a robust correlation with NT-proBNP and Scr and is independently linked to CKD progressing to ESRD.
慢性肾脏病（CKD）与心血管疾病（CVDs）的发病率和死亡率密切相关，其中左心室心肌损伤最为常见。本研究旨在使用三维斑点追踪成像（3D-STI）评估 CKD 患者的左心室（LV）功能障碍。
共纳入 110 例 CKD 患者和 55 名健康志愿者进行超声心动图检查。根据估计肾小球滤过率（eGFR）将 CKD 患者分为 CKD1 组和 CKD2 组。通过二维斑点追踪超声心动图（2D-STE）和三维斑点追踪超声心动图（3D-STE）参数评估心功能，应变以绝对值表示。收集三组的临床和超声心动图参数并进行比较，通过相关性和接收者操作特征（ROC）曲线分析评估 3D-STI 评价 CKD 患者 LV 功能障碍的价值，并通过单因素和多因素分析确定 CKD 进展为终末期肾病（ESRD）的危险因素。
在 CKD2 组中，与对照组和 CKD1 组相比，2D-左心室射血分数（LVEF）、3D-LVEF、2D 左心室整体纵向应变（2D-LVGLS）、3D-LVGLS 和 3D-左心室整体圆周峰值应变（LVGCS）明显恶化，后两者之间有统计学差异（均 p<0.05）。3D-LVGLS 的绝对值与 N 末端 B 型利钠肽原（NT-proBNP）和血清肌酐（Scr）呈强相关（r=-0.598，-0.649，均 p<0.001）。ROC 曲线分析表明，3D-LVGLS 和 3D-LVGCS 对 LV 收缩功能的诊断效能均优于 2D-LVGLS。单因素和多因素分析显示，3D-LVGLS 与 CKD 进展为 ESRD 独立相关。
3D-LVGLS 和 3D-LVGCS 可有效检测 CKD 患者的 LV 功能障碍。具体而言，3D-LVGLS 与 NT-proBNP 和 Scr 呈强相关，且与 CKD 进展为 ESRD 独立相关。
