Application Of 3-dimensional Speckle Trackingimaging In Assessing The Right Ventricular Function Of Patients With Uremia Peri-peritoneal Dialysis

Objective: To assess the value of three-dimensional speckle tracking imaging(3D-STI)in right ventricular(RV) function of uremia patients undergoing peritoneal dialysis(PD).Methods: [1] 66 uremic patients with preserved left ventricular ejection fraction(>50% LVEF) undergoing peritoneal dialysis and 20 healthy control participants underwent both standard and 3D- STI assessment. The PD patients with right ventricular ejection fraction(RVEF) >45% composed group A(45 patients), and all other patients were included in group B(21 patients). Left ventricular end-diastolic inner diameter(LVIDd), left ventricular end-systolic inner diameter(LVISd), interventricular septum thickness(IVSd), left ventricular ejection fraction(LVEF), right ventricular diastolic diameter of(RVDd) were recorded by conventional ultrasound. Calculating the tricuspid annulus maximum pressure reflux by simplified Bernoulli formula(PG)=4V2.Estimating right atrium pressure according to right atrium diameter.Pulmonary artery systolic pressure(PASP)= PG+RAP in the case of the right ventricualr outflow tract without obstruction.RV dynamic three-dimensional models were obtained from the apical four chamber view. The images were stored and analyzed on EchoPAC workstation. Right ventricular end diastolic volume(RVEDV), right ventricular end systolic volume(RVESV), right ventricular ejection fraction(RVEF), and right ventricular global longitudinal peak systolic strain(RVGLS),right ventricular global radial peak systolic strain(RVGRS),right ventricular global circumferential peak systolic strain(RVGCS),right ventricular global area peak systolic strain(RVGAS) were measured by 3D-STI. Categorical variables were compared between groups using the ANOVA. Bland–Altman plots for interobserver differences and average values were generated for GAS, GLS, GRS, and GCS.[2] 35 uremia patients who strarted to peritoneal dialysis were enrolled. LVIDd, LVISd、IVSd、LVEF、RVDd、right ventricular fractional area change(RVFAC) and PASP were recorded by conventional ultrasound. RVEDV、RVESV、RVEF、 RVGLS、RVGRS、RVGCS and RVGAS were measured by 3D-STI.Categorical variables were compared using paired-samples T test.Results: [1] Conventional ultrasound measurements: Compared with the control group, LVIDd、 LVISd、 IVSd of group A increased(P <0.05), and so in group B. PASP of group B was higher than the control group.Three Dimensional speckle tracking calculation results: GLS in Group A was significantly lower than the GLS in the control group. In patients with abnormal right ventricular function, GCS、 GAS、 GRS and GLS were lower in the group B than in healthy controls. Compared with group A subjects, GCS、GRS and GAS of group B were more lower.[2] Conventional ultrasound measurements: Compared with the pre- peritoneal dialysis, LVIDd、LVISd、IVSd、PASP、LVEF and the volume of the right ventriculer of the peritoneal dialysis group had no significant differences(P> 0.05).Three Dimensional speckle tracking calculation results: Compared with preperitoneal dialysis, RVEDV and RVESV of the peritoneal dialysis were significantly lower(P<0.05 for all). RVGLS was significantly higher than pre-peritoneal dialysis group(P <0.05), but RVEF、RVGAS、RVGCS and RVGRS had no significant differences(P> 0.05 for all).Conclusions: [1] The right ventricular GLS of patients undergoing peritoneal dialysis decreased prior to the decline before the right ventricular ejection function became worse.In uremic patients undergoing peritoneal dialysis with abvious abnormal right ventricular systolic function, GLS、GRS、GAS and GCS were all decreased in uremic patients undergoing peritoneal dialysis.GLS is a sensitive index marker for assessing right ventricular function in patients with peritoneal dialysis.[2] The reduce of right ventricular volume was detected in uremia patients with early stage peritoneal dialysis by three-dimensional speckle tracking technology. RVGLS can be used as an important parameter for right ventricular function improvement in peritoneal dialysis patients as an early period peritoneal dialysis and was sensitive to the change of preload.