三维斑点追踪成像评价血液透析伴发瓣膜钙化患者左室收缩功能

目的应用三维斑点追踪成像(3D-STI)定量评价血液透析伴发瓣膜钙化患者的左室收缩功能。方法 55例血液透析患者根据是否伴发瓣膜钙化分为钙化组26例和无钙化组29例,另选健康志愿者30例为正常对照组。各组分别行常规超声心动图和3D-STI检查,测量室间隔厚度(IVST)、左室后壁舒张末期厚度(LVPWT)、左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD)、左室射血分数(LVEF)、左室整体峰值纵向应变(GLS)、整体圆周应变(GCS)、整体面积应变(GAS)、整体径向应变(GRS)及左室心肌质量(LVM),计算左室心肌质量指数(LVMI);分析各组上述参数的差异。结果与正常对照组比较,钙化组和无钙化组IVSd、LVPWd及LVMI均显著增加,GLS、GCS、GAS、GRS均显著降低(均P<0.05),LVEDD、LVESD、LVEF各组比较差异均无统计学意义。与无钙化组比较,钙化组IVSd、LVPWd及LVMI均显著增加,GLS、GCS、GAS、GRS均显著降低(均P<0.05)。结论血液透析患者左室收缩功能减低,伴有瓣膜钙化者左室重构和左室收缩功能受损更明显;3D-STI可准确评价血液透析伴发瓣膜钙化患者的左室收缩功能,具有较好的临床应用价值。

Evaluation of left ventricular systolic function in hemodialysis patients with valve calcification by three-dimensional speckle tracking imaging

ObjectiveTo evaluate left ventricular systolic function in hemodialysis patients with valvular calcification(VC)by three-dimensional speckle tracking imaging(3 D-STI).MethodsFifty-five hemodialysis patients with normal left ventricular ejection fraction(LVEF)were divided into VC group(26 cases)and NVC group(29 cases).30 healthy volunteers were selected as control group.All groups were underwent conventional echocardiography and 3 D-STI.Interventricular septum thickness(IVST),left ventricular posterior wall end diastolic thickness(LVPWT),left ventricular end systolic diameter(LVESD),left ventricular end diastolic diameter(LVEDD),LVEF,left ventricular global peak longitudinal strain(GLS),global circumferential strain(GCS),global area strain(GAS),global radial strain(GRS)and left ventricular mass(LVM)were measured,and left ventricular myocardial mass index(LVMI)was calculated.The differences of the above parameters in each group were analyzed.ResultsCompared with the control group,IVSd,LVPWd and LVMI in VC group and NVC group were significantly increased,GLS,GCS,GAS and GRS were significantly decreased(all P<0.05),while LVEDD,LVESD and LVEF had no significant difference.Compared with NVC group,IVSd,LVPWd and LVMI were significantly increased in VC group,GLS,GCS,GAS and GRS significantly decreased(all P<0.05).ConclusionCardiac systolic function is impaired in hemodialysis patients,left ventricular remodeling and myocardial systolic function are more impaired in VC patients than those in NVC patients.3 D-STI can accurately evaluate the left ventricular systolic function in hemodialysis patients with VC,which has better clinical application value.