Value of layer-specific strain technique to the evaluation of early left ventricular systolic function of patients undergoing maintenance hemodialysis for end-stage renal disease
Objective To evaluate the left ventricular systolic function of patients undergoing maintenance hemodialysis(MHD)for end-stage renal disease(ESRD)by layer-specific strain technique,and to explore the value of layer-specific strain parameters in early evaluation of left ventricular systolic dysfunction in MHD patients.Methods Thirty-three patients with ESRD received MHD(MHD group)in the First Affiliated Hospital of Jiamusi University from September,2022 to September,2023,and another 31 healthy volunteers received physical examination at the same time(control group).Both two groups received routine echocardiography to record left ventricular mass index(LVMI),left ventricular end-systolic volume(LVESV),left ventricular end-diastolic volume(LVEDV),left ventricular relative wall thickness(RWT)and left ventricular ejection fraction(LVEF).Layer-specific strain technique was used to obtain two-dimensional dynamic images at three long-axis views of apical two-chamber,three-chamber and four-chamber and at three short-axis views of left ventricular basal segment,middle segment and apical segment.The left ventricular global longitudinal strain,longitudinal strains of the endocardium,midmyocardium and epicardium(LSendo,LSmid,LSepi),global circumferential strain(GCS),and circumferential strains of the endocardium,midmyocardium and epicardium(CSendo,CSmid,CSepi)were recorded.The left ventricular strain parameters were compared between two groups.ROC curve was plotted to evaluate the efficiency of layer-specific strain parameters on assessing left ventricular systolic dysfunction in MHD patients.Results The systolic blood pressure,diastolic blood pressure,and the levels of serum creatinine,triacylglycerol,blood phosphorus and parathyroid hormone were higher in MHD group[140.0(127.5,168.0)mmHg,90.0(82.0,99.0)mmHg,724.9(530.9,893.3)μmol/L,(1.93±0.78)mmol/L,(1.82±0.40)mmol/L,281.9(229.9,389.7)ng/L]than those in control group[119.0(106.0,133.0)mmHg,77.0(70.0,82.0)mmHg,75.0(64.0,88.0)μmol/L,(1.41±0.60)mmol/L,(1.17±0.18)mmol/L,41.0(28.0,51.0)ng/L](P＜0.05).The levels of albumin and blood calcium were lower in MHD group[(38.45±5.66)g/L,(2.16±0.20)mmol/L]than those in control group[(47.84±4.05)g/L,(2.43±0.15)mmol/L](P＜0.05).There were no significant differences in the body mass index,plasma glucose and total cholesterol between two groups(P＞0.05).LVMI,LVESV,LVEDV and RWT were greater in MHD group[136.2(117.9,159.4)g/m2,46.0(39.5,55.2)mL,(128.05±18.80)mL,(0.46±0.04)cm]than those in control group[79.2(67.6,87.9)g/m2,33.4(29.4,39.4)mL,(97.23±14.80)mL,(0.38±0.03)cm](P＜0.05),and there was no significant difference in LVEF between two groups(P＞0.05).The absolute values of GLS,LSendo,LSmid,LSepi,GCS,CSendo,CSmid and CSepi were lower in MHD group[(-15.45±2.85)％,(-18.02±3.22)％,(-15.34±2.87)％,(-12.99 士 2.59)％,(-18.22±2.16)％,(-26.26±2.79)％,(-17.38±2.52)％,(-11.01±1.78)％]than those in control group[(-19.92±2.60)％,(-23.38 士 2.62)％,(-19.81±2.85)％,(-16.57±2.44)％,(-20.53±2.75)％,(-27.96±3.39)％,(-20.38±2.68)％,(-13.24±2.55)％](P＜0.05).When the optimal cut-off values of GLS,LSendo,LSmid,LSepi,GCS,CSendo,CSmid and CSepi were-17.29％,-20.07％,-17.03％,-14.50％,-20.67％,-28.10％,-17.93％and-12.20％,the AUCs for predicting left ventricular systolic dysfunction were 0.883(95％CI:0.801-0.964,P＜0.001),0.904(95％CI:0.831-0.977,P＜0.001),0.864(95％CI:0.777-0.951,P＜0.001),0.845(95％CI:0.751-0.939,P＜0.001),0.737(95％CI:0.613-0.861,P=0.001),0.645(95％CI:0.508-0.782,P=0.046),0.795(95％CI:0.686-0.905,P＜0.001),and 0.761(95％CI:0.640-0.883,P＜0.001),the sensitivities were 75.8％,72.7％,75.8％,78.8％,93.9％,81.8％,63.6％and 75.8％,and the specificities were 90.3％,96.9％,87.1％,80.6％,51.6％,45.2％,83.9％and 74.2％,respectively.Conclusions The layer-specific strain technique can early evaluate the regional changes of left ventricular systolic function in ESRD patients undergoing MHD.LSendo,LSmid,LSepi,CSendo,CSmid and CSepi decrease significantly,and all of them can be used to evaluate early left ventricular systolic dysfunction,among which LSendo has the highest diagnostic efficiency.
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