| Objective:The purpose of this study was to evaluate the application value of non-invasive myocardial work in quantitative evaluation of left ventricular myocardial function in hemodialysis and non-dialysis uremic patients with preserved left ventricular ejection fraction(LVEF),and to provide an early and quantitative method for clinical evaluation of cardiac function in uremic hemodialysis patients.Methods:A total of 150 patients with uremia who underwent echocardiography in the Department of Ultrasound medicine,The First Affiliated Hospital of Nanchang University from October 2020 to October 2021 were selected.According to whether they underwent hemodialysis,they were divided into non-hemodialysis group(NHD group)and maintenance hemodialysis group(MHD group).During the same period,40 healthy subjects with matched gender and age were selected as normal control group.The general clinical data and laboratory indicators of all subjects were collected: age,gender,height,weight,blood pressure,heart rate,serum creatinine,blood urea nitrogen,hemoglobin level,etc.GE Vivid E95 color Doppler ultrasonography was used for echocardiography and dynamic images of five cardiac cycles on the three-chamber,two-chamber and four-chamber sections of the apical heart were stored.Echo pac203 software was used to offline analyze the left ventricular global strain and myocardial work parameters of the three groups: peak strain dispersion(PSD)and global longitudinal strain(GLS),global work index(GWI),global work efficiency(GWE),global constructive work(GCW)and global wasted work(GWW).The data were analyzed by SPSS 23.0 statistical software.Results:1.There was no significant difference in age,gender composition,heart rate,BMI,BSA,DBP among the three groups(all P>0.05).The SBP,SCR,BUN,NT-pro BNP,PTH,Hs-CRP and blood phosphorus in NHD group and MHD group were higher than those in control group(all P<0.05).The ALB,HDL-C,Hb and blood calcium were lower than those in control group(all P<0.001).The Hb and ALB in NHD group were lower than those in MHD group(all P<0.001).The SCR,BUN and Hs-CRP in NHD group were higher than those in MHD group(all P<0.05).2.The LVEDD,IVST,LVPWT,LVMI,LVEDV,LVESV and E/e’ in uremic patients were higher than those in the control group,and the E/A ratio was lower than that in the control group(all P<0.001).The LVMI in the MHD group was significantly higher than that in the NHD group,and the difference was statistically significant(P<0.001).There was no significant difference in LVESD,LVEF and LVFS among the three groups(all P>0.05).3.Compared with the control group,the GLS,GCW,GWI,and GWE of the MHD group and the NHD group were decreased,while the PSD and GWW were increased(all P<0.05).The difference was statistically significant(all P<0.05).4.Multiple regression analysis showed that LVMI,SBP,SCR and BUN were correlated with overall myocardial work parameters.Conclusion:1.Although LVEF is preserved in uremic patients,the overall left ventricular strain and the overall left ventricular myocardial work have been impaired.2.Compared with two-dimensional echocardiography and speckle tracking imaging,the parameters of myocardial work derived from the left ventricular pressurestrain loop are more sensitive for the assessment of myocardial function in uremic maintenance hemodialysis patients.3.LVMI,SBP,SGR and BUN were correlated with overall myocardial work parameters.4.Noninvasive myocardial work can early detect the subclinical myocardial dysfunction of left ventricle and provide an important basis for clinical optimization of treatment. |
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