背景:血液透析(HD)患者容易发生各种心血管并发症。二维斑点追踪超声心动图(2DSTE)是一种用于早期心肌功能障碍检测的创新技术,即使正常射血分数(EF)。
目的:与传统超声心动图相比,我们旨在使用2DSTE检测常规血液透析患者的左心室(LV)功能障碍。
方法:该研究包括30例终末期肾病(ESRD)患者,根据左心室质量指数(LVMI)细分为左心室肥厚(LVH)的第1组(n=19)和无LVH的第2组(n=11)。另招募30名健康对照受试者作为第3组。EF,平均收缩期速度(Sa),和2DLV应变被用作LV收缩功能的测量。舒张功能指标包括E/A比和E速度/舒张早期峰值速度。
结果:关于通过传统超声心动图评估的LV收缩和舒张功能参数,我们发现第1组和第2组之间没有显著差异.然而,使用2DSTE,我们观察到平均Sa速度存在显著差异(p=0.025),平均低压应变(p=0.03),二维整体纵向应变(GLS)(p=0.03),E/Ea(p=0.003),和左心室心肌性能指数(MPI)(p=0.006)。此外,LVMI与左心室舒张末期内径(LVEDD)呈显著正相关(p<0.01,r=0.63),通过2D测量的EF(p=0.034,r=0.39),二尖瓣E/A比值(p=0.03,r=0.49),和二尖瓣E/Ea(p<0.01,r=0.72)。LVMI与2D平均LV应变之间存在显着的负相关(p=0.034,r=-0.39)。
结论:我们得出的结论是,即使在EF正常的患者中,2DSTE在检测早期左心室收缩和舒张功能障碍方面比常规回声更敏感。
BACKGROUND: Patients on hemodialysis (HD) are prone to various cardiovascular complications. Two-dimensional speckle tracking echocardiography (2D STE) is an innovative technique for early myocardial dysfunction detection, even with normal ejection fraction (EF).
OBJECTIVE: We aim to detect left ventricle (LV) dysfunction in regular hemodialysis patients using 2D STE compared to traditional echocardiography.
METHODS: The study comprised 30 patients with end-stage renal disease (ESRD), subdivided according to left ventricular mass index (LVMI) into group 1 with left ventricular hypertrophy (LVH) (n=19) and group 2 without LVH (n=11). Another 30 healthy control subjects were recruited as group 3. The EF, average systolic velocity (Sa), and 2D LV strain were taken as measures of LV systolic function. The indicators for diastolic function included the E/A ratio and E velocity/peak early diastolic velocity.
RESULTS: Regarding the parameters of LV systolic and diastolic functions assessed by traditional echocardiography, we found no significant difference between groups 1 and 2. However, using 2D STE, we observed significant differences in the average Sa velocity (p=0.025), average LV strain (p=0.03), 2D global longitudinal strain (GLS) (p=0.03), E/Ea (p=0.003), and LV myocardial performance index (MPI) (p=0.006). Also, a significant positive correlation was found between LVMI and left ventricular end-diastolic diameter (LVEDD) (p<0.01, r=0.63), EF measured by 2D (p=0.034, r=0.39), mitral E/A ratio (p=0.03, r=0.49), and mitral E/Ea (p<0.01, r=0.72). There was a significantly strong negative correlation between LVMI and 2D average LV strain (p=0.034, r=-0.39).
CONCLUSIONS: We concluded that 2D STE is more sensitive than a conventional echo in detecting early LV systolic and diastolic dysfunction even in patients with normal EF.