The Evaluation Of Right Ventricular Function In Patients With End-stage Renal Disease Hemodialysis By Speckle Tracking Technique

Purpose:The use of speckle tracking imaging techniques to evaluate right ventricular function in patients with end-stage renal disease hemodialysis,and to explore the effect of right ventricular myocardial function on various segments.Materials and Methods:Observation group:A total of 60 patients with end-stage renal disease undergoing hemodialysis(HD)in our Department of Nephrology Internal Dialysis Room from January 2017 to December 2017 were selected,of which 33 were male and 27 were female,aged 35-55.Years old,average age(44.36±7.15)years old.Inclusion criteria:The primary disease is renal disease,including 28 cases of diabetic nephropathy,12 cases of hypertensive nephropathy,15 cases of glomerulonephritis,and 5 cases of polycystic kidney disease caused by chronic renal failure.For regular hemodialysis,patients were treated with bicarbonate dialysate for regular hemodialysis.For regular hemodialysis,patients were treated with bicarbonate dialysate for regular hemodialysis.Dialysis frequency was 3 times a week for 4 hours.Anticoagulants are unfractionated heparin or low molecular weight heparin calcium.All patients were treated with an arteriovenous fistula,and echocardiography was performed within 1-2 hours after completion of hemodialysis.Check and record general information for each patient,including: age,gender,systolic blood pressure,diastolic blood pressure,etiology of kidney disease,and dialysis time,creatinine,urea nitrogen,and hemoglobin.Simpson's method was used to measure left ventricular ejection fraction(LVEF> 50%)and right ventricular ejection fraction(RVEF> 35%).All laboratory data were completed within the same week of the patient's echocardiographic examination.The observation group was divided into pulmonary hypertension group according to pulmonary artery systolic pressure ? 35 mm Hg and <35mm Hg,a total of 28 cases and non-PH group,a total of 32 cases.Normal control group: 20 healthy subjects matched for gender,age,and weight in the outpatient physical examination were selected as the normal control group,including 12 males and 8 females,aged 35-55 years,with an average age of(43.40±4.99)years.The right and left heart system diseases were excluded in both the observation group and the control group: including right heart pacemaker installation,right ventricular outflow tract obstruction,right ventricular myocardial infarction,right heart failure,pulmonary valve stenosis,and tricuspid valve device Pulmonary hypertension related diseases: including chronic thromboembolic disease,interstitial lung disease,chronic obstructive pulmonary disease,connective tissue disease;excluded primary heart disease,thoracic deformity,and poor quality ultrasound images.All subjects underwent routine echocardiography at rest and obtained a parasternal left ventricle long-axis view and apical 4-chamber view.General parameters were measured: left ventricular end-diastolic diameter(LVIDd),left ventricular end-systolic diameter(LVIDs),interventricular septum(IVS),left ventricular posterior wall(LPWd),right ventricular end diastolic area(RVEDV),and right ventricular end-systolic area(RVESV),The right ventricular area change ratio(RVFAC)was obtained and the tricuspid valve systolic displacement(TAPSE)was measured under M-mode ultrasound.The systolic peak velocity(Sm),early diastolic peak velocity(Em),and late diastolic peak velocity(Am)were measured on the TDI images.And calculate the ejection time(ET),isovolumetric relaxation time(IVRT)and isovolumic contraction time(IVCT),to get right ventricular myocardial work index(MPI),referred to as Tei index.The final values of all these parameters were recorded as the average of three cardiac cycle measurements.Offline analysis was performed using the QLAB 9.0 software CMQ program.Measure and record myocardial strain(S),systolic peak strain rate(SRs),early diastolic peak strain rate(SRe),late diastolic peak strain rate(SRa)in all segments of the free wall.Results:(1)There was no significant difference in gender,age,heart rate,body mass index(BMI)and dry weight between non-PH group,PH group and normal control group(P> 0.05).The systolic blood pressure,diastolic blood pressure,serum creatinine,and blood urea nitrogen in non-PH group and PH group were all higher than those in the control group(P < 0.05).Among them,PASP increased and hemoglobin decreased in the PH group compared with the non-PH group(P< 0.05).(2)Compared with the normal control group,the LVIDd,LVIDs,IVSd,LVPWd,and RVIDd in non-PH group and PH group increased,and the difference was statistically significant(P<0.05).There was no statistically significant difference in RVFAC between the non-PH group and the control group(P>0.05),and the RVFAC was decreased in the PH group compared with the control group(P<0.05).(3)TDI decreased in the control group,non-PH group and PH group in turn,and the difference was statistically significant(P<0.05).There was no significant difference in the MPI between the non-PH group and the control group and the PH group(P>0.05).The difference between the MPI group and the control group was statistically significant(P<0.05).(4)In the non-PH group,compared with the normal group,the S,SRs,SRe,and SRa in the basal segment and the middle segment of the right ventricle were all decreased,and the difference was statistically significant(P<0.05).S,SRs were in the PH group and the non-PH group.For comparison,the reduction was more significant and the difference was statistically significant(P<0.05),while the apical segment was not statistically significant between the three groups(P<0.05).In conclusion:1.In patients with end-stage renal disease with hemodialysis,the ventricular ejection fraction is still within the normal range,and the vertical strain and strain rate of the basal and middle segments of the right ventricle are decreased.2.Spot tracking technology can be used to evaluate the function of the right ventricle in patients with end-stage renal disease hemodialysis.3.Speckle tracking technology is better than two-dimensional ultrasound in the absence of early pulmonary hypertension,the detection of a decrease in the function of the right ventricular myocardium,providing valuable information for the timely initiation of appropriate treatment.