Evaluation Of The Left Ventricular Function And Mechanical Synchronicity In Patients With Diabetic Nephropathy Using Single-beat Real-time Three-dimensional Echocardiography

Objective: to explore the application value of single-beat real-timethree-dimensional echocardiography（sRT-3DE）on the left ventricularfunction and16segmental mechanical synchronicity of the patients withDiabetic nephropathy.Methods: The diabetes and diabetic nephropathy group:According to the1999who diabetes diagnosis standard,and exclusion of type1diabetes,urinarytract infection and primary renal disease and patients with other heart diseasean the same time.The occurrence and development of diabetes,renal damage isdivided into five periods,choice of this study was to early diabeticnephropathy patients,namely a trace a albuminuria,UAER continued in20-200μg/min.Choose between January2013and December2013in our hospitalendocrinology of diabetes and diabetes and diabetic nephropathy patients asthe research object,including diabetes group of40cases,25cases of male,15cases were female,age38-69,the average age was (54.4±7.7);Male Malediabetic nephropathy group of30cases,20cases,10cases of women,age29-74,the average age was (53.8±9.7).Out of the following:the recent surgeryor trauma patients;For dialysis patients;Combined tumor patient;The patientswith sinus rhythm,and poor image quality,all entrants to sinus rhythm.Normal control group:random collection of outpatient service of30casesof normal healthy people,male18cases,12cases were female,age29-69,theaverage age is about(51.3±12.0).Always are the body health, no history, suchas diabetes,hypertension,coronary heart disease of liver and kidney function isnormal,physical examination,X line,electrocardiogram and echocardiographywere no exception.the case group and patients’ age,gender,height,thedifference of heart rate had no statistical significance. Instrument: The SIEMENS ACUSON SC2000ultrasound diagnosticinstrument with single-beat real-time three-dimensional volume imagingsystem,4Z1c full volume probe，frequency2.8MHz, scanning angle90°×90°,volume frame frequency≥12volume per second, synchronouselectrocardiogram. Image processing used TOMTEC imaging system and LVAanslysis software.Image acquisition method and index:first of all tell patients torelax,connection of synchronous lead electrocardiogram,take the left side,withelectrocardiogram consecutive regular QRS complex after the ultrasonicdiagnostic instrument system is set to left heart volumetric analysismodel,placed4z1c full volume probe in patients on the left side of the chestwall ares nowadays,according to the the standard2d four-chamber view,andadjust the depth to image resolution and gain the best modest,start after4dkeys to real-time3d full volume scanning,in standard,stable and clear the leftventricle after3d full volume images,frozen image,press the key dynamicstorage,the instrument automatically choose single cardiac cycle of dynamicthree-dimensional images for storage.Both diabetes and diabetic nephropathygroup and normal control group to return to three to five complete dynamicimage and store of single cardiac cycle.Into the LVAanalysis software to carryon the analysis,the system automatically identify the endocardialboundary,calculatesSDI,DDI,POSTCONTR,PRECONTR,LVEDV,LVESV,LVEF,DISPES and DISPED,data from the heart rate correction,expressed in theform of a percentage of the cardiac cycle,At the same time, the ensemble leftventricular time-volume curve and16segments time-volume curve of leftventricle were displayed.Statistical analysis:tje parameters are the average of the three cardiaccycle,the parameters of measurement data with,mean..standard deviation,saidmore measurement data comparison with analysis of variance betweengroup,two further comparison with q test,The relevant comparison to do linearcorrelation analysis,data statistical analysis using SPSS13.0statisticalsoftware analysis,P<0.01,the difference was statistically significant. Results:1Compared with normal control group,the case groups of16segmentSDI,DDI,DISPES,DISPED of left ventricle were significant different (P<0.01).Between the case groups the difference was statistically significant(P<0.01).The16segments time-volume curve of left ventricle of the case groupwere disordered, on the contrary, the curve of the normal control group weresmooth and ordered.2Compared with normal control group,the case groups16segment the sum ofPostcontr and Precontr differences were statistically(P＜0.01).But betweenthe case groups,it had no statistically significant difference(P＞0.01).The sumof Postcontr and Precontr of case groups is greater than the sum of thenormal group.3LVEF were statistically significant difference between the three groups(P＜0.01),systolic function cases group were lower than normal group.4LVEF of diabetic nephropathy was negative correlated with the16segmentSDI of left ventricle(r=-0.599，P＜0.01).Conclusion:1Diabetic nephropathy patients with left ventricular segmental systolicsynchronicity and diastolic synchronicity is pure diabetes patients and normalperson is poor;2The case groups patients, with left ventricular volume and contraction16segments volume index further prompt the sum of left ventricular systolicsynchronicity worse than normal;The16segment end-diastolic andend-systolic dispersion were enlarged than normal population.3Diabetic nephropathy patients with left ventricular systolic function is lowerthan the normal people;4There was relevance between LVEF and the16segment SDI of left ventriclein the diabetic nephropathy;5sRT-3DE is a visual,simple, and effective new method for clinical toevaluate left ventricular function and mechanical dyssynchrony of the diabeticnephropathy.