Evaluation Of Left Ventricular Systolic Function In Patients With Uremia By Two-dimensional Speckle Tracking Of Tissue Mitral Annular Displacement And Real-time Three Dimensional Echocardiography

Objective：To explore the application value of two-dimensional speckletracking of tissue mitral annular displacement(TMAD) and real-time threedimensional echocardiography(RT-3DE) on the left ventricular systolicfunction and systolic synchrony in patients with uremia. To provide a simple，effective new method for clinical accessment on the systolic function.Methods：Uremia group(group A):40uremic patients were collectedfrom May2013to February2014in our hospital Nephrology Departmentbefore they undergone dialysis treatment. It included26males，14females，ages from22to68and average age43.73±10.95years old, the repeatabilityof the echocardiography results were good and the Electrocardiograph(ECG)was normal. The control group(group B) included22health，14males and8females，ages from24to77and average age40.77±14.88years old, normalECG, no history of high blood pressure, diabetes, heart disease and kidneydisease etc, The sex, weight age matched with the uremia group, AppliedPHILIPS iE33color Doppler ultrasound diagnostic instrument with X5-1transducer(1.0-5.0MHz)．All patients were examined by regularly ultrasoniccardiography to measured left ventricular end-diastolic diameter (LVDd),left atrium end systolic diameter (LADs), and the thickness of ventricularwalls, using M-Teichholz method and simplify the bi-planar Simpson method obtain the left ventricular ejection fraction(M-EF, sim-EF),left ventricular endsystolic volume(M-ESV, sim-ESV), end diastolic volume(M-EDV,sim-EDV). The images of apical four-chamber, apical two-chamber sectionwere acquisited in four successive stable cardiac cycles and stored. QLAB9.0TMAD software measured the maximal systolic displacement of the fourpoints of mitral annulus(Ds)， the time to peak systolic displacement(T)，displacement of the middle of the mitral annular(Dm), percent of standardizeddisplacement from the middle of the mitral annular to apex(Dm%)．ActivatingFull Volume imaging in apical four chamber, full-volume images werecollected in four consecutive cardiac cycles and stored, QLAB3DQAdvanced software measured the LVEF, left ventricular end systolicvolume(ESV),end diastolic volume(EDV), the time to minimum systolicvolume of16-segmental(except apical section of the left ventricular segments)standard deviation(Tmsv16-SD), Tmsv12-SD, Tmsv6-SD, maximaldifference(Tmsvl6-Dif), Tmsv12-Dif, Tmsv6-Dif,the time to minimumsystolic volume of16-segmental standard deviation and maximal differenceas a ratio of R-R interval (Tmsvl6-SD％, Tmsvl2-SD％,Tmsv6-SD％,Tmsvl6-Dif％, Tmsvl2-Dif％, Tmsv6-Dif％).The datas were measured threetimes and take their averages． We used SPSS13.0statistical software toanalysis those datas,which were expressed by mean±standard deviation．Thetwo groups’ datas were compared by the Independent-sample T test.Normal distribution datas between groups were compared with one-wayanova(LSD).The correlations between mitral annular displacement(MAD)parameters and LVEF, systolic synchrony parameters and LVEF wereanalyzed, statistical significance when P<0.05． Results:1. There were no differences in sex, weight, age between two groups(P>0.05); In uremia group, creatinine, systolic blood pressure(SBP), diastolicblood pressure(DBP),heart rate, LADs and LVDd increased, IVSd andLVPWd thickened，EDV and ESV measured by RT-3DE method, Simpsonmethod and M-Teichholz method increased, EF decreased, except M-EF thedifferences were statistically significant(P<0.01或P<0.05)．2. EF in two groups measured by RT-3DE method and Simpson methodwere lower than measured by M-Teichholz method(P<0.05);EF in two groupsmeasured by RT-3DE method and Simpson method had no statisticdifferences(P>0.05).3. Compared with control group, the four points’ Ds, the averages of Ds,Dm and Dm%in uremia group decreased， the time to peak systolicdisplacement increased，All of the differences were statistically significant(P<0.01)．4. MAD parameters correlated well with EF measured by RT-3DEmethod in two groups(P<0.01)，the correlation coefficient of Dm％washigher than others, and the correlation coefficient in control group was higherthan in uremia group; the correlation coefficients of the MAD parameterswere higher when one point was placed at the chest than placed at the apicalendocardial(P<0.01).5.The correlations between M-EF and EF (RT-3DE), sim-EF and EF(RT-3DE) in control group were better than in uremia group,and thecorrelation coefficient of sim-EF was higher than M-EF(P<0.05).6.Compared with control group, systolic synchrony parameters werehigher in uremia group， the differences were statistically significant exceptTmsv12-SD%(P<0.01). Left ventricular systolic synchrony parameters was negative correlated with EF, the correlation coefficient of Tmsv16-SD,Tmsv16-SD%,Tmsv16-Dif and Tmsv16-Dif%were higher.Conclusion:1. The heart rates and blood pressure increased in uremic patients, thedamage of uremic cardiomyopathy both in morphological structure andfunction were obvious, LADs, LVDd increased，IVSd, LVPWd thickened,leftventricular systolic function decreased．2.M-EF overestimated the left ventricular systolic function, it is lessexact than sim-EF and EF(RT-3DE).3. MAD parameters of the four points reflected the left ventricularsystolic function decreased within the uremic patients, MAD canbetter assess the left ventricular systolic function than M-Teichholz methodand Simpson method.4.Ds, Dm and Dm％can reflect the left ventricular systolic functionbetter when one point was placed at the chest and Dm%was the best．Basedon two-dimensional speckle tracking imaging, When one point was placed atthe chest, mitral annulus displacement measured by TMAD software had itsunique advantages used to evaluate the left ventricular systolic function inuremic patients，which is expected to become a routine method to quantitativeevaluation the global left ventricular systolic function．.5. The left ventricular systolic synchrony in Uremia group was poorerthan in control group; left ventricular systolic function was affiliated with leftventricular systolic synchrony, they affected each other；RT-3DE cancompare the left ventricular16segments systolic synchrony in one cardiaccycle of uremic patients，which provide a visual, non-invasive and rapid new tool for clinic to evaluate left ventricular systolic synchrony and systolicfunction.