| Background Chronic kidney disease(CKD)is a common disease that seriously affects people’s life and health.It is usually accompanied by many complications such as hypertension,anemia and cardiovascular disease,among which cardiovascular system complications are the primary cause of death in CKD patients.Thus,accurate evaluation of Left ventricular function in CKD patients is of great significance in preventing cardiovascular events.Pressure strain loops(PSL),based on two-dimensional speckle tracking technique and combining non-invasive left ventricular pressure and myocardial strain,is a new method to evaluate myocardial work.And this method has a good correlation with invasive measurements by cardiac catheterization.At the same time,the pressure strain loop technique takes into account the effect of afterload on myocardial strain,which is more objective in evaluating myocardial work compared with global longitudinal strain(GLS).The feasibility of PSL evaluating myocardial work has been used in different diseases such as coronary heart disease,hypertension,dilated cardiomyopathy and hypertrophic cardiomyopathy.Objective The study aimed to quantitatively evaluate the global myocardial work of left ventricle in patients with chronic kidney disease(CKD)by pressure-strain loops(PSL)technology.Methods Forty-two patients with chronic kidney disease(CKD)in People’s Hospital of Zhengzhou University from February 2019 to October 2019 were chosen as case group.All CKD patients with LVEF ≥ 50% were enrolled.According to the decreased level of the glomerular filtration rate(GFR),CKD patients were divided into CKD 2 ～ 3 stage group(n=21)and CKD 4 ～ 5 stage group(n=21),and 21 healthy volunteers were selected as control group.Clinical data from all subjects were collected.Left ventricular end-diastolic diameter(LVEDd),left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),left ventricular end-diastolic wall thickness(LVPWTd),end-diastolic ventricular septal thickness(IVSTd)and left ventricular ejection fraction(LVEF)were measured by trans thoracic echocardiography.Left ventricular mass index(LVMI)was calculated.The global myocardial work parameters including the global work index(GWI),the global constructive work(GCW),the global wasted work(GWW),the global work efficiency(GWE)were measured by pressure-strain loops technology,and the differences of the parameters among the three groups were compared.Intraclass correlation coefficient(ICC)was used to evaluate the consistency of myocardial work parameters.Result1.Comparison of general clinical data Systolic and diastolic blood pressure in the CKD 2 ～ 3 stage group and CKD 4 ～5 stage group were significantly higher than those in control group.Compared with the CKD 2 ～ 3 stage group,the systolic blood pressure of the CKD 4 ～ 5 stage group was higher.And the differences were statistically significant(all P < 0.05).There was no significant difference in sex,age,heart rate and body surface area(BSA)between the three groups(all P>0.05).2.Comparison of left ventricular echocardiographic parameter The IVSTd,LVPWTd and LVMI in the CKD 2 ～ 3 stage group were significantly higher than those in the control group(P<0.05).Compared with the control group,the IVSTd,LVPWTd,LVMI,LVEDV and LVEDd in the CKD 4 ～ 5stage group were significantly increased(P<0.05).There was no significant difference in LVESV and LVEF among the three groups(P>0.05).3.Comparison of left ventricular myocardial work parameters Compared with the control group,the GWI、GCW、GWW in the CKD 2 ～ 3stage group and CKD 4 ～ 5 stage group were significantly higher than those in the control group and the GWE was lower.The difference was statistically sigificant(all P < 0.05).Compared with the CKD 2 ～ 3 stage group,the GWI and GCW of the CKD 4 ～ 5 stage group were increased.The differences were statistically significant(all P < 0.05).But there was no significant difference in GWW and GWE(P >0.05).There was no significant difference in GLS between the three groups(P>0.05).4.Repeatability and reproducibility The consistency of GWI,GCW,GWW and GWE was good.ICC of GWI,GCW,GWW and GWE in the intra-observer were 0.963,0.945,0.928 and 0.924,respectively.And the ICC of GWI,GCW,GWW and GWE in the inter-observer were0.929,0.937,0.952 and 0.959,respectively.Conclusions1.PSL can quantitatively evaluate the changes of left ventricular myocardial work in CKD patients.2.PSL can early detect the abnormity of left ventricular myocardial work in CKD patients with preserved left ventricular ejection fraction,providing a method for the evaluation of left ventricular systolic function in CKD patients. |
PDF Full Text Request