Evaluation Of Left Ventricular Volume And Function Changes Before And After Dialysis In Patients With Uremia By Full-volume Real-time Three-dimensional Echocardiography

Objective:Discuss the application value of Real-time three-dimensional echocardiography, when evaluate left ventricular volume, function and changes of systolic and diastolic synchronicity, for Patients with uremia before and after Hemodialysis. To provide a simple, intuition and effective new method for Clinical Judgment and monitoring the cardiac function change for patients with uremia before and after Hemodialysis.Methods:Uremia team: All the selected patients with the chronic renal failure, according to the fifth standard of America national kidney foundation K/DOQI, GFR/CCr less than 0.17ml/s(10ml/min), serum creatinine more than 8mg/dl, patients with obvious Uremia Clinical symptoms(Gastrointestinal symptoms, anemia, metabolic acidosis and so on. In additional, both of them exclude obvious idiopathic heart disease, ischaemic heart disease and arrhythmia. Picked 40 uremia patients as study object from September 2014 to May 2015, who had accepted dialysis treatment in hemodialysis Center of our hospital. Among them 22 males, 18 females, age between 25-76, average age 50.2±14.1, Maintenance hemodialysis time from 6 months to 10 years.The selected patients do hemodialysis 3 times per week, 4 hours per time, blood volume 250-280ml/min, passage for blood purification are permanent arteriovenous fistula or semi permanent internal jugular vein catheterization, and used poly sulfone dialyser, bicarbonate dialysate. During the process of dialysis, no patient has dehydration sign, breath difficulty, or uncontrolled high blood pressure.Normal control group-Random picked 40 healthy person from clinic, 20 males, 20 females, age between 23-75, average age 46.9±13.2, no family kidney diseases, no cardiac diseases after health check, electrocardiogram and ultrasonic cardiogram check.Instrument:Facility equipment: The SIEMENS ACUSON SC2000 ultrasound diagnostic instrument with single-beat real-time three-dimensional volume imaging system, 4Zlc full volume probe, frequency 1.7-2.8MHz, scanning angle 90°×90°, Image processing used LVA analysis software, synchronous ECG lead.Image acquisition and indicator: While begins, the echocardiographic Image acquisition and indicator: begins set the echocardiograohic, diagnostic system for left ventricular volume analysis paaem. Let patients to take a left lateral position, connect synchronous electrocardiogram, wait for consecutive stable QRS complex, put 4Z1 c probe on the cardiac apical area of the chest, get the standard two dimensional 4-chamber view, and then, adjust image to the best articulation, press 4D key to start real-time three-dimensional volume scanning. After acquired a standard, clear and stable volume image of left ventricle, freeze image, save a single cardiac cycle of dynamic three-dimensional image. Every patient save three volume image for so. Areanalysis. Start the LVA software, apply it to analyse achieved images, endocardial border were automatic identified, calculates LVEDV, LVESV, LVEF, ESSI, EDSI, SDI, DDI, DISPES and DISPED, all the data has been corrected by the heart rate. Express the data with the percentage of the cardiac cycle. The left ventricular volume time curves of 16 segments and the left ventricular volume time curves were displayed at the same time. Do the test once instantly before dialysis and after dialysis 1-2 hours.Statistic analysis: used the series data which get from SPSS 13.0 statistic analysis software, data applied mean±standard deviation(x±s); the data comparison between uremia team and control group used t test of 2 independent sample, the test standard set with ?=0.05; comparison before and after dialysis set with t test match, used P<0.05 as deviation has statistic meaning.Results:1 Left ventricular volume and function index for uremia before and after dialysis: LVEDV both higher than control group, EF both lower than control group; ESSI, EDSI both higher than control group; left ventricular segment volume change synchronous index: diastolic dyssynchrony index(DDI16), systolic dyssynchrony index(SDI16), mean end-diastolic time(MES16), mean end-systolic time(MES16) and dispersion end-systole(DISPES16), dispersion end-diastole(DISPED16), all higher than control group. The differences has statistic meaning(P <0.05).2 Left ventricular volume and function index after dialysis treatment for uremia patients: LVEDV and LVEF both lower than before treatment, differences has statistic meaning(P<0.05), ESSI and EDSI no obvious differences(P>0.05); Left ventricular segment volume change synchronous index: DDI16 and SDI16 both lower than before treatment, DISPES16, DISPED16 both lower than before treatment, difference has statistic meaning(P<0.05). MED16 and MES16 differences no statistic meaning(P>0.05).Conclusion :1 The left ventricular volume load of uremia patients are obvious increased than normal person, the left ventricular EF lower than normal, the shape of left ventricular changed, and much more similar with ball; the left ventricular segment of DDI16 and SDI16 are both worse than normal, further more the left ventricular of DISPES16 and DISPED16 are bigger than normal, MES16 and MED16 time are longer than normal.2 The left ventricular volume load reduced after dialysis for uremia patients, left ventricular EF lower than before dialysis; no obvious change for left ventricular shape; DDI16 and SDI16 are obvious better than before dialysis; further more, the left ventricular of DISPES16 and DISPED16 are bigger than normal.3 Hemodialysis treatment can significantly improve the left ventricular front load increase which is caused by remaining for uremia patients, in the meanwhile it can improve the function of segment systolic and diastolic for left ventricular. RT-3DE is a simple intuition and effective new method in clinic to evaluate uremia patients' left ventricular shape function and synchronicity.