Evaluation Of Left Atrial Function In Patients With Different Stages Of Chronic Kidney Disease By Strain Rate Imaging

Objective:1.Which period began to appear left atrial myocardial damage in chronic kidney disease.2.the changes of left atrial myocardial damage In the process of the progress of chronic kidney disease(CKD)periods.3.Explore application value of the strain rate imaging for evaluation of left atrial function in chronic kidney disease.Methods:Select 58 patients with chronic kidney disease which was defined standard according to the 2012 global kidney tissue KDOGO [1] from March 2016 to October 2016 in our hospital.All the patients were divided into 3 groups according to the level of Glomerular Filtration Rate(GFR),group A(19 cases,CKD1 ~ 2stage):GFR ?60 ml/min / 1.73 m2,group B(22 cases,CKD3 stage): GFR 30 ~ 59 ml/min / 1.73 m2,group C(17cases,CKD4 stage): GFR 15 ~ 29 ml/min / 1.73m2 and 19 cases of normal control group(N group).All patients were examined using Philips I E33 color ultrasonic diagnostic instrument,S5-1 probe,the frequency of 3.5 ~ 5 MHz,with left side,quiet breathing,after fitting of electrocardiogram(ecg),collecting three consecutive cardiac cycle dynamic images of apical 2 chamber view and apical 4 chamber view,then storage;And then convert probe to TDI conditions,acquisition three consecutive cardiac cycle dynamic images of apical 2 chamber view and apical 4 chamber view,and offline analysis.measure conventional two-dimensional echocardiography parameters by using Simpson method(such as:left atrium maximum volume LAVmax,left atrium minimum volume LAVmin,left atrial presystolic volume LAVp,left atrial passive emptying volume LAPEV,left atrial active emptying volume LAAEV,left atrial passive emptying fraction LAPEF,left atrial active emptying fraction LAAEF,left atrial total emptying fraction LATEF).Under the condition of the QLAB,offline analysis,select apical 2chamber view and apical 4 chamber view under the condition of TDI,manual trace of interest areas,adjust its width,make it accord with the endocardial and epicardial surface,run software to get four segments strain and strain rate curve of left atrial wall,interatrial septum,anterior wall and inferior wall myocardial,measure the SRs,SRe,SRa.The measurements were measured three times in a row,get the averaged.Results:1.The conventional two-dimensional parameter comparison LAVmax,LAVmin and LAVp of group B,group C increase compare to group A and group N(P <0.05);LAPEV and LAPEF of Group B and group C decrease compare to group A and group N(P < 0.05),left atrial volume in patients with CKD stage 3and stage 4 enlarge,at the same period,the storage function and pipeline functions of left atrium are impaired;there was no significant difference between group N and group A,group B and group C data(P > 0.05);there was no significant difference in four groups LAAEF(P > 0.05),it shows that the development of chronic kidney disease(CKD)patients.4,left atrial booster pump function was not damaged from CKD stage 1 to CKD stage 4.2.Strain rate parameters comparison SRs,SRe: Left atrial front wall,lower wall,lateral wall and interatrial septum of group B and group C lower compare to group A and group N(P < 0.05),beside group N and group A,group B and group C has no significant statistical difference(P > 0.05);SRa: there were no significant difference in anterior wall,lower wall,side wall,and interatrial of four groups septum.Strain rate imaging parameters results is the same to conventional 2 d results,it also shows that left atrium storage function and pipe functionis damaged in CKD stage 3 and stage 4,left atrial booster pump function has not been damaged from CKD stage 1 to stage 4.3.Strain rate SRe/a comparison strain rate SRe/a of group N and group A > 1, SRe/a in lateral wall of group B and interatrial septum of group C and group B is also greater than 1,but there are still differences compared to group A and group N(P < 0.05);SRe /a of Group B,group C front wall and lower wall?SRe /a of group C lateral wall< 1(P < 0.05),and SRe/a in anterior wall and lower wall further decline from the group B to the group C(P < 0.05);Similar to traditional echocardiography measured mitral valve flow spectrum peak peak with A,E,E/A value of left ventricular diastolic function of reaction,SRe/A can response the diastolic function of left atrium(corresponding to the pipeline and storage functions);left atrial diastolic function is impaired in CKD stage3 and stage 4,front wall and lower wall of left atrial is the mainly damaged myocardial.Conclusion:In this study,the SRI measurement results is the same with conventional parameter measurement results,but SRI is more consistent and simple to measure and accurate,it can evaluate the different stages of left atrial function and the extent of damage and can evaluate left atrial function in patients with chronic kidney disease,which can be for early clinical intervention from the basis...