| Objective:The cardiovascular system damage is the main cause of death in patients with uremia,the assessment for the changes in cardiac and vascular function timely and effectively is important to clinical. In our study, combined with conventional ultrasound, tissue doppler imaging and real-time three-dimensional echocardiography compare the left ventricular function and endothelial function in uremia patients with different blood pressure levels.To summarizes the changes features of the uremic patients with different blood pressure in left ventricular function and endothelial function and to discuss the impact of blood pressure on the left ventricular function and endothelial function in uremia patients.Methods:32 uremic patients as the research object, according to patients whether with hypertension divided into two groups: Uremic patients with normal blood pressure (B) 16 patients, 11 males and 5 females; Uremic patients with hypertension (C) 16 patients, 11 males and 5 females. The control group (A): 20 normal subjects, 10 males and 10 females. Applied to two-dimensional, echocardiography,real-timethree-dimensi- onal,echocardiography,pulsed Doppler (PWT), tissue doppler imaging (TDI) ultrasound respectively measured Left atrial diameter(LAD),interventricu-lar septum thickness (IVST), left ventricular end diastolic diameter(LVDd), left ventricular posterior wall thickness(LVPWT) ;Left atrial maximum volume (LAVmax), left atrial minimal volume (LAVmin), left atrial volume before contraction (LAVp), left ventricular end-diastolic volume (LVEDV) and left ventricular end systolic volume (LVESV);Mitral early diastolic peak flow velocity (E peak), late diastolic peak flow velocity (A peak), isovolumic relaxation time (IVRT); mitral valve levels of intervals,lateral,anterior and inferior early diastolic peak velocity (Ea), late diastolic peak velocity (Aa);Brachial artery diameter before compression (HAD0) and brachial artery diameter after pressurization (HAD1). Calculated left ventricular mass index (LVMI), left atrial active emptying volume contraction (LASV), left atrial ejection fraction (LAEF), left ventricular ejection fraction (LVEF), E / A values, Ea / Aa values, E / Ea value and the reaction rate of change of brachial artery diameter (EDD)Results:1. Left ventricular structure: B group and A group compared, LAD increased (p <0.05), IVST, LVDd, LVPWT, LVMI no significant difference, C group and A group compared, LAD, LVDd increased, IVST, LVPWT thickening, the difference was statistically significant (p <0.05), LVMI increased significantly, (p <0.01); C group and B group compared,LAD increased, IVST, LVPWTT thickening, and the difference Statistically significant (p <0.05), LVMI increased, the difference was statistically significant (p <0.01), LVDd was no significant difference.2. Left ventricular function: Compared with A group, B group: E, Ea, E /A and Ea/Aa were lower, A,Aa and E/Ea were higher, IVRT prolonged, the difference was statistically significant (p <0.05), compared with A group, C group :E and E/A were reduced, A increased, IVRT prolonged, the difference was statistically significant (p <0.05),Ea and Ea/Aa was reduced, Aa and E/Ea was increasedthe ,difference was statistically significant (p<0.01); Compared with B group,C group :Ea and Ea/Aa reduced, Aa and E/Ea increased significantly (p<0.05), A increased, IVRT prolonged,E and E/A reduced, the difference was not statistically significant;Compared with A group, B group LAVmax, LAVmin, LAVp, LASV,LVEDV,LVESV LAEF were increased; the difference was statistically significant (p <0.05);Compared with A group,B group LAVmax, LAVmin,LAVp,LASV,LAEF were increased; the difference was statistically significant (p<0.01)LVEDV and LVESVwere increased,the difference was statistically significant (p<0.05)C group and B group compared:LAVmax, LAVmin, LAVp, LASV and LAEF were increased,difference was statistically significant (p <0.05), B group and A group, C group and A group, C group and B group compared, LVEF was not statistically different.3. Vascular endothelial function: B group Compared with A group, EDD were reduced,the difference was statistically significant (p <0.05), C group with A group, EDD were reduced,the difference was statistically significant (p <0.01),and Compared with B group ,the C group reduced significantly, the difference was statistically significant (p <0.05). 4. Correlation analysis showed that:LVMI and blood pressure moderately correlated, Ea/Aa, E/Ea, LASV, LAEF, EDD and blood pressure were low correlation,and LVEF was no correlation with blood pressure.Conclusions:1. Left ventricular structure:Uremic patients with normal blood pressure LAD increased; Uremic patients with high blood pressure LAD increases, IVST and LVPWT thickness, LVMI increased. Compared with normal blood pressure, uremic patients with hypertension ,changes in cardiac structure is significant.2. Left ventricular function:Uremia patients with normal blood pressure Ea/Aa and E/Ea reduced,LAVP and LAEF increased;Uremic patients with hypertension Ea/Aa and E/Ea was lower significantly,LAVP and LAEF increased significantly; Two groups patients with uremia no significant change in LVEF . Therefor,compared with uremic patients in normal blood pressure, uremic patients with hypertension reduced significantly in left ventricular diastolic function.But left ventricular systolic function change is not obvious.3. Vascular endothelial function: Uremic patients with normal blood pressure EDD reduced,and uremic patients with hypertension EDD was significantly reduced. Compared with uremic patients in normal blood pressure , Uremic patients with hypertension was significantly reduced in endothelial function.4. Blood pressure was correlated with LAD, LVMI, Ea / Aa, E / Ea, LASV, LAEF and EDD. The study showed that hypertension has different degree effects on left ventricular structure and function and endothelial function in uremic patients. |
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