Evaluation Of Left Atrial Volume And Function In End-stage Renal Disease Dialysis Patients By Real-time Three-dimensional Speckle Tracking Imaging

Objective:End-stage renal disease(ESRD)is a common clinical disease,its incidence is gradually increasing in recent years,and it has become one of the important diseases endangering human health.Maintenance hemodialysis(MHD)is the main treatment for uremic patients.Cardiovascular complications have a serious impact on the survival and quality of life of hemodialysis patients.The purpose of this study was to evaluate the left atrial volume and function of hemodialysis patients at different times using real-time three-dimensional speckle tracking imaging(RT3D-STI).Methods:88 uremic patients who were treated with MHD in the affiliated Hospital of Qingdao University from February to August 2021 were divided into three groups according to different dialysis time: group A(n = 37),group B(n = 28),group C(n = 23)and 30 healthy volunteers as normal control group.All subjects first used the S5-1 probe for routine two-dimensional echocardiographic examination,and continuously collected two-dimensional gray-scale and color dynamic images of four cardiac cycles,as well as spectral images,and measured according to the guidelines of the American Association of Echocardiography.Left ventricular end-diastolic diameter(LVEDd),interventricular septal thickness(IVST)and left atrial anterior-posterior diameter(LAD)were measured on parasternal long-axis view,and left ventricular ejection fraction(LVEF)was measured by apical four-chamber view.Simpson double plane method was used.The three-dimensional images of apical four-chamber cardiac section were obtained by X5-1probe.Using RT3D-STI technique,global longitudinal strain(GLS),global radial strain(GRS),global circumferential strain(GCS)and time-volume curve of left atrium were obtained.According to the curve and ECG,the maximum volume of left atrium(LAVmax)and the minimum volume of left atrium(LAVmin)were obtained.left atrial active presystolic volume(LAVpre),and body surface area standardization.The left atrial volume indexes LAVImax,LAVImin and LAVIpre were obtained,and the total left atrial emptying fraction [LAEF=(LAVImax-LAVImin)/ LAVImax × 100%],passive emptying fraction [LAp EF =(LAVmax-LAVIpre)/ LAVImax × 100%] and active emptying fraction[LAa EF=(LAVIpre-LAVImin)/ LAVImin × 100%] were calculated.The above data were analyzed and the differences of the parameters in the four groups were compared.Pearson linear correlation was used to analyze the correlation between global strain parameters and dialysis time.Bland-Altman test was used to test the consistency.Results:LVEDd,LAD,IVST,Tei index,E/e’,LAVI max,LAVIpre and LAVImin in the case group were higher than those in the control group,while E/ A,LAEF,LAp EF,GLS,GRS and GCS in the case group were lower than those in the control group.GLS and GCS in group B were lower than those in group A(all P < 0.05).Emax A,GLS,GCS,LAVIpre,LAVImin and LAp EF in group C were lower than those in group A(all P < 0.05).The correlation analysis showed that there was a correlation between the whole strain parameters and dialysis time(GLS,GCS: ritual moment 0.588,-0.576(all P < 0.0001),and the correlation coefficient of GLS and GCS was higher.Conclusion:With the increase of MHD time,the left atrial volume increases,the channel function is impaired,and the pump function increases in the early stage,but it may decrease in the later stage,and the myocardial strain parameters of left atrium decrease.There is a strong correlation between GLS and GCS.Real-time three-dimensional speckle tracking technique can be used for early evaluation of left atrial volume and function in uremic hemodialysis patients,and comprehensive evaluation of left atrial volume and function in uremic patients with different hemodialysis time.It is of great significance to guide clinical rational intervention treatment.