Assessment Of Right Ventricular Function By Three-dimensional Speckle Tracking In Uremic Patients Underwent Peritoneal Dialysis

Objective: To assess right ventricular(RV) function in patients with uremiaunderwent peritoneal dialysis using three-dimensional speckle tracking imaging(STI),andto preliminary study on right ventricular function in each segment.Method:69uremic patients underwent peritoneal dialysis and31age-matchednormal individuals(PASP≤40mmHg,1mmHg=0.133KPa) acted as a control group wereincluded in the study.All uremic patients underwent peritoneal dialysis peritoneallydialysis at least one month,and were completed echocardiography after completion ofperitoneal dialysis1h.Conventioanal echaocardiography results prompted left ventricularejection fraction and right ventricular ejection fraction values is normal （LVEF＞50%，RVEF＞35%）.All patients underwent peritoneal dialysis were divided into two groupsaccording to pulmonary artery systolic pressure (PASP),Group A consisted of36patientswith a PASP≤40mmHg,Group B contained33patients with a PASP＞40mmHg.Using GE Vivid E9-mode echocardiography measured traditional indicators of rightventricular function values and left ventricular function values.Measuring right ventriculardiameter(RVDd) at tricuspid annulus and left ventricular diameter(LVIDd) at the mitralannulus by the apical four-chamber view.Measuring right ventricular ejection fraction andleft ventricular ejection fraction values by Simpson method.Calculating the tricuspidannulus maximum pressure reflux by simplified Bernoulli formula（PG）=4V2.Estimatingright atrium pressure(RAP＝5mmHg,10mmHg,15mmHg) according to right atriumdiameter.Pulmonary artery systolic pressure(PASP)=PG+RAP in the case of the rightventricualr outflow tract without obstruction.RV dynamic three-dimensional model was obtained from the apical four-chamberview, afterwards the images were stored and analyzed on EchoPAC workstation. RV global longitudinal peak systolic strain(GLS), global circumferential peak systolicstrain(GCS),global radial peak systolic strain(GRS),end-systolic volume(RVESV),end-diastolic volume(RVEDV) and RV twelve segments longitudinal peak systolic strain(LS),radial peaksystolic strain(RS),circumferential peak systolic strain(CS) from each group weremeasured and compared using three-dimensional speckle tracking.Results:1.RV GLS were significantly decreased in uremic patients group A and Bcompared with group N (P＜0.05). RV GLS were even lower in group B compared withgroup A(P＜0.05). No significant difference was found in RV GRS, GCS among group A,group B and group N(P＞0.05).2.RV anterior basal segments and lateral basal segments（LS、RS、CS） weresignificantly decreased in uremic patients group A and B compared with group N (P＜0.05). RV anterior basal segments and lateral basal segments（LS、RS、CS） were evenlower in group B compared with group A(P＜0.05). No significant difference was found inRV other segments（LS、RS、CS）among group A, group B and group N(P＞0.05).Conclusions:1.Even RV systolic function is still at a normal level in patients withuremic peritoneal dialysis,but its longitudinal myocardial deformation capacity has been asearly as right ventricular systolic function decline,and early in the radial,circumferentialdirection of the global deformation capacity.2.RV anterior basal segments and lateral basal segments longitudinal,radial andcircumferential myocardial deformation capacity in patients with uremic peritoneal dialysishas been as early as right ventricular other segments decline.3.RV systolic function is not the three directions of myocardial systolic functionsuperimposed.In other words,RV general deformation capacity is not the accumulatoin oflocal myocardial deformation capacity.4.The application of three-dimensional speckle tracking technology can accuratelydetect subclinical right ventricular dysfunction, providing the basis for early clinicalintervention.