Strain Rate Imaging Assessing Regional Left Ventricular Function In Uremic Patients After High-flux Hemodialysis

Objective:Strain rate imaging assessing regional left ventricular function in uremicpatients after high-flux hemodialysis.Methods:A group of30uremic patients were taken high-flux hemodialysistreatment for6months,to get the patients left ventricular conventionalechocardiographic parameters,left ventricular regional strain rate parameters andclinical laboratory indicators before and after the high-flux hemodialysis (HFHD).Leftventricular conventional echocardiographic parameters are following up:left ventricularinternal diameter (LVDd),left atrial(LA),the septal thickness (IVSTd),left ventricularposterior wall thickness(PWTd),mitral spectrum E peak、A peak,left ventricularejectionfraction(LVEF);Regional left ventricular strain rate parameters are following up:peaksystolic strain rate(SRs),early diastolic strain rate(SRe) and later diastolic strainrate(SRa) for each segments of myocardium.Clinical laboratory indicators includinghemoglobin,blood urea nitrogen,creatinine,total cholesterol,triglycerides,C-reactiveprotein,interleukin-6,serum calcium,phosphorus and parathyroid hormone(PTH).Agroup of20healthy adults were enrolled normol controls,to get the left ventricularconventional ultrasound echocardiography parameters and regional left ventricularstrain rate parameters.Results:1.Left ventricular structure and functional parameters LA and A peak in uremiagroup were bigger than those in the normol group（P<0.05).E peak and E/A in uremiagroup were lower than those in the normol group（P<0.05).LA、E peak、A peak and E/Ahad no statistically difference between pre-dialysis and post-dialysis of the uremiagroup（P>0.05）.IVSTd,LVDd,PWTd and LVEF had no statistically difference amongthe three groups（P>0.05）.2,left ventricular systolic function and diastolic function parameters SRs,SRe and SRe/SRa of each segments of left ventricular wall in uremia group were smaller thanthose in the normol group（P<0.05).After dialysis,SRs、SRe and SRe/SRa of eachsegments of left ventricular wall were larger than those in the pre-dialysis（P<0.05).Compared with the control group,the SRa of IVSbasal was smaller in uremiagroup(P<0.05),the SRa had no statistically difference among IVSmid、LWbasal、LWmid、IWbasal、IWmid、AWbasal、AWmid（P>0.05）.Compared with pre-dialysis,theSRa of IVSmid, LWbasal, LWmid, IWmid, and AWbasal were smaller after dialysis(P<0.05),the SRa was no significant difference between IVSbasal and IWbasal (P>0.05).3,clinical laboratory indicators After dialysis,hemoglobin wasincreased(P<0.01),total cholesterol,parathyroid hormone,and interleukin-6were lowerthan those in pre-dialysis(P<0.05),there were no statistically difference among bloodurea nitrogen,creatinine,triglycerides,C-reactive protein,blood calcium and serumphosphorus dialysis(P>0.05).There was negatively correlated among left ventricularstrain rate parameters,total cholesterol and interleukin-6(P<0.05),the left ventricularstrain rate parameters including the SRs of IVSmid, LWbasal, IWbasal IWmid and theSRe of IVSmid, LWbasal.Conclusions:1,Uremic patients with normal left ventricular systolic function had already beenseen a reduction of regional myocardial systolic and diastolic function,but the damageof left ventricular regional systolic and diastolic function can be early detected by strainrate imaging.2,High-flux hemodialysis can improve regional systolic and diastolic function ofthe left ventricle in patients with uremia.The reason may be that high-flux hemodialysisis able to remove some large and medium-sized molecules,main factors includeparathyroid hormones,cytokines and so on,of couse,these factors are not easily removedby the general dialysis.3,The strain rate imaging technology is an effective method to evaluate regionalleft ventricular function.It can be sensitive to detect the changes of left ventricularregional systolic and diastolic function,when the global left ventricular function has notbeen changed.The parameter of SRs,SRe and SRe/SRa is relatively stable andreliable.Strain rate imaging technology as a non-invasive, sensitive detective methodscan provide an objective basis for the treatment evaluation of high-flux hemodialysis.