| [Objective]:This paper aims to evaluate the right ventricular function of patients with chronic kidney disease（CKD）by using 4D-RV-Volume technology,analyze the right ventricular function between normal volunteers and patients with CKD at various clinical stages,and explore the application value of 4D-RV-Volume technology in clinical quantitative evaluation of right ventricular function,so as to provide diagnosis and treatment basis for improving the prognosis of patients with CKD.[Methods]:case group:100 patients with confirmed chronic kidney disease were selected,and their estimated GFR（eGFR）was used as an indicator of renal function evaluation.They were divided into five stages:CKD1 group（stage 1-3,mild-moderate）and CKD2 group（stage4-5,severe）.Specific grouping:CKD1 group（stage 1-3,mild to moderate）: 43 cases（23 males and 20 females）,aged（18-75）years,with an average age of（50.42 ± 20.51）years;CKD2 group（stage 4-5,severe）: 57 cases（31 males and 26 females）,aged（20-75）years,with an average age of（49.68 ± 13.98）years.Diagnostic criteria of renal function:（1）CKD1 stage: GFR ≥ 90 ml /min;（2）CKD2 stage: 60 ～ 89ml/min;（3）CKD3 stage: 30 ～ 59ml/ min;（4）CKD4 stage: 15 ～ 29ml/ min;（5）CKD5 stage: < 15ml/ min or dialysiscontrol group:40 normal volunteers（21 males and 19 females）were recruited in the same period,aged（20-65）years,with an average age of（36.43 ± 16.72）years.140 subjects were examined by color Doppler echocardiography.The dynamic images of apical four chamber view,parasternal left ventricular long axis view and major artery short axis view were collected,and the conventional ultrasonic parameters were measured.In addition,collect the three-dimensional full volume dynamic images of apical four chamber cardiac section dominated by the right ventricle,import the images into echopac workstation for offline analysis,and obtain the right ventricular function and strain parameters.[Results]:1.The pulmonary artery systolic pressure related parameters VTR and PASP were increased and RVOTAc T was decreased in CKD2 group（P<0.05）;2.The three-dimensional volume parameters RVEDV and RVESV of right ventricle in CKD2 group were significantly higher than those in control group（P<0.05）;3.The three dimensional functional parameters of right ventricle TAPSE,RVFAC and RVEF in CKD1 and CKD2 groups were lower than those in control group（all P<0.05）,and the decrease was more obvious in CKD2 group（P<0.05）.4.RVGS of right ventricular strain index in CKD1 group and CKD2 group was lower than that in control group（P < 0.05）,and the decrease was more o-bvious in CKD2 group（P<0.05）;5.eGFR was positively correlated with RVEF,FAC,TAPSE and RVGS（all P<0.05）;EGFR was negatively correlated with RVEDV and RVESV（P<0.05）.There was no significant correlation between RVDd base and RVDd mid and eGFR（P>0.05）.Multiple linear regression analysis showed that RVEF and TAPSE were independent predictors of eGFR.6.Three-dimensional RVFAC was positively correlated with RVEF and RVGS（P<0.05）;RVGS was negatively correlated with PASP（P<0.05）and positively correlated with TAPSE（P<0.05）.7.The optimal cut-off point of RVEF for the diagnosis of right ventricular dysfunction in patients with CKD was 46.25%（sensitivity 90%,specificity 93%）.RVGS was 18.65%（sensitivity 88%,specificity 73%）.8.ICC correlation coefficient analysis showed that RVFAC,RVEF,RVGS and TAPSE measurements were consistent among the same operator and different operators（all P < 0.05）.[conclusion]:Quantitative evaluation of right ventricular function in patients with different clinical stages of CKD by 4D-RV-volume technology has important reference value for evaluating the condition,guiding the treatment and judging the prognosis of patients with CKD,which makes up for the deficiency previously limited to the complex congenital structure of right ventricle. |
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