Evaluation Of The Left Ventricular Function And Mechanical Synchronicity In Patients With Uremic Myocardiopathy Using Real-time Three-dimensional Echocardiography

Objective: To explore the application value of real-time threedimensional volume quantitative technique (RT-3DE) on the left ventricularfunction and Mechanical synchrony of uremic myocardiopathy patients. Toprovide a simple, non-invasive and effective new method for clinical judgmenton uremic myocardiopathy.Methods: Patient group:Chronic renal failure patients, according to theAmerica national kidney foundation’s "Disease Outcomes Quality Initiative"(K/DOQI)stage5standard: GFR/Ccr<0.17ml/s(10ml/min),Scr>707umol/L(8mg/ml)and patients with the obvious clinical symptoms; Echocardiographicheart enlarged,left ventricular wall thickening, myocardial echo abnormalities,moving range reduced, with or without valve calcification, the pericardialeffusion, and rule out other primary or secondary heart disease. In thisstudy,30uremic patients were involved from August2010to December2011in our hospital Dialysis center who have not received dialysis treatment as theresearch object,19cases were male, female11cases, aged19-70years, meanage43±8.3years old.There were no serious idiopathic cardiomyopathy,coronary heart disease and arrhythmia history, electrocardiography of theheart is normal and sinus rhythm.Normal control group:20cases of healthy people were collectedrandomly, including12cases were male, female8cases, aged from20to66years, mean age40.5±10.6years old, no history of heart disease, the gender,height, weight, and heart rate between two groups have no statisticallysignificant differences.Instruments:The Siemens Acuson SC2000ultrasound diagnosticinstrument with the real-time three dimensional volume image analysis software equipped,4Z1c full volume probe,frequency2.8MHz, synchronouselectrocardiography.Image acquisition: While begins, set the echocardiographic diagnosticsystem for left ventricular volume analysis pattern. Let patients to take a leftlie, connect synchronous electrocardiography, wait for consecutive stable QRScomplex, put4Z1c probe on the cardiac apical area of the chest, get thestandard two dimensional4-chamber view, and adjust image to the bestarticulation, press4D key to start real-time three dimensional volumescanning. After a clear, stable and standard real-time volume image of leftventricular acquired, save a single cardiac cycle of dynamic three dimensionalimage for software analysis.Start the Simens real-time three dimensional volume analysis software,apply the left ventricular volume analysis software to analyse achieved seriesimages, endocardial border were automatic identified, calculates LVEDV,LVESV and LVEF. At the same time, the ensemble left ventriculartime-volume curve and left ventricular17segments time-volume curve weredisplayed,17and16segments (except apical section of the left ventricularsegments) systolic dyssynchrony index (SDI-17, SDI-16), diastolicdyssynchrony index (DDI-17, DDI-16), Mean Contraction Time and MeanRelaxation Time(MES17,MED17)were calculated,all the data has beencorrected by the heart rate. Apply SPSS13.0statistical software to conductanalysis of the obtained data, data expressed with mean±standard deviation.Normal control group and the case group compared with mean differences by“t” test. The relevant comparison to do linear correlation analysis, it was astatistical significance when P<0.05.Results:○1Compared with control group, the reduce of LVEF hadstatistically significant (P<0.01)in the UM group;○2Between UM group andthe contral,17and16segment (middle section and basal segment) contractionand relaxation dyssynchrony index were significant different;○3There was nostatistic difference between left ventricular mean contraction and relaxation time(P>0.05);○4Left ventricular ejection fraction was negative correlatedwith left ventricular systolic dyssynchrony index (r=-0.753, P<0.01).Conclusion:○1In the UM group, left ventricular systolic function waslower than normal population;○2The left ventricular diastolic and systolicsynchronicity of UM patients was poor than normal population;○3There wasrelevance between Left ventricular systolic function and left ventricularsystolic dyssynchrony, both inter-influence each other;○4RT-3DE is a rapid,simple, accurate and non-invasive tool for clinic to evaluate left ventricularfunction and mechanical dyssynchrony of UM patients.