| Objective: TO evaluate the left ventricular global systolic function of uremic patients with different left ventricular configurations before renal transplantation by three-dimensional speckle tracking imaging,and to explore its clinical significance.Methods: A total of 85 patients planned to undergo renal transplantation were selected,who were treated in the Affiliated Hospital of Qingdao University from September 2018 to August 2020.Inclusion criteria:(1)The primary disease of the patient was renal disease;(2)Underwent regular hemodialysis for 1 ～ 3 years,and the patient measured value of blood creatinine before dialysis was greater than 707 umol / L;Excluded cases:(1)History of previous kidney transplantation,heart surgery and other operations;(2)Previous old myocardial infarction,heart valve disease and various cardiomyopathy;(3)Various secondary kidney diseases and hereditary kidney diseases such as polycystic kidney;(4)Unclear ultrasonic image.Moreover,24 healthy volunteers who underwent physical examination in the Affiliated Hospital of Qingdao University and whose physical examination indexes were normal in the same period were selected as the control group.85 uremic patients undergoing renal transplantation were divided into four groups according to different left ventricular configurations: left ventricular normal geometric(LVN group);left ventricular centripetal remodeling group(LV-CR group);left ventricular centripetal hypertrophy(LV-CH group)and left ventricular eccentric hypertrophy(LV-EH group).Philips IE-33 high-grade color Doppler ultrasound diagnostic instrument is used.The diagnostic instrument is equipped with s1-5 and x1-5probes.The patients with uremia and the control group are tested by routine and three-dimensional echocardiography respectively,and the test data and image storage are recorded.3-4 dynamic images of four cardiac cycles are stored.Then,clear and standard stored images are screened out,The off-line analysis is realized by Tom Tec workstation software.The software can automatically track and trace the left ventricular intimal surface,and adjust the position of the trace line in the form of manual assistance,so that the endocardial surface can achieve consistent fit.The software automatically tracks the three-dimensional spatial motion of the inner muscle spots in the region of interest,and obtains the overall longitudinal strain(GLS),global radial strain(GRS)and Global circumferential strain(GCS)parameter.The differences between two-dimensional parameters and three-dimensional overall strain parameters of five groups of subjects were compared,and the inter group analysis was carried out to complete the drawing of ROC,focusing on the sensitivity of 3D-STI overall strain parameter detection,and the repeatability test was performed by Bland Altman test.Results:(1)Compared with the control group,the levels of GLS in uremia group decreased,and the levels of GRS and GCS in LV-CH group and LV-EH group decreased(P < 0.05);Compared with LVN group,the levels of GLS,GRS and GCS in LV-CH group and LV-EH group decreased(P < 0.05);Compared with LV-CR group,the levels of GLS,GCS in LV-CH group and the lenels of GLS,GCS and GRS in LV-EH group decreased(P < 0.05);Compared with LV-CH group,GLS and GCS in LV-EH group decreased(P < 0.05).(2)According to ROC curve,three-dimensional speckle tracking technology can sensitively detect myocardial remodeling,and GLS is the most sensitive.(3)Repeatability test: the measurement results of GLS measured by 3D-STI technology within and between observers are relatively stable and have good consistency.Conclusion: 3D-STI technology is sensitive,noninvasive and reproducible,and GLS is the best index.The technology can effectively evaluate the left ventricular systolic function of uremic patients with different ventricular configurations before renal transplantation,help to reasonably select receptors,formulate individualized treatment plans,and better improve the prognosis of patients. |
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