Evaluation Of Right Ventricular Systolic Function In Patients With Chronic Renal Failure By Three Dimensional-speckle Tracking Imaging

Objective:To evaluate the clinical value of three-dimension speckle-tracking imaging(three-dimension speckle-tracking imaging,3D-STI)in evaluating the right ventricular systolic function in patients with chronic renal disease(CKD),and to diagnose and treat myocardial function in patients with CKD.Loss provides an objective and valuable informationMethods: 34 patients with mild chronic renal insufficiency(CKD1-3 group),44 patients with moderate to severe chronic renal insufficiency(CKD4-5 group),who accepted treatment in the West Coast of Qingdao University Affiliated Hospital from January 2016 to May 2018,and 41 healthy volunteers(control group)were enrolled.The Philips EPIQ 7C color Doppler ultrasound system,S5-1 probe(1~5MHz)and X5-1(1~3MHz)probes are equipped with TOMTEC workstation analysis software.The data obtained were measured three times and averaged.Routine echocardiography was performed: the subject was calmly breathing,the left side was placed,and the electrocardiogram was connected.The S5-1 two-dimensional probe was used for routine scanning.According to the measurement method recommended by the American Society of Echocardiography,the ventricular septal end-diastolic thickness(IVSTd)was measured on the long-axis side of the sternum,and the left ventricular ejection fraction(LVEF)and right ventricular area change score(RVFAC)were measured by the Simpson method.In the apical four-chamber view,the tissue motion tricuspid annulus displacement(TAPSE)was measured by M-mode ultrasound,and the maximum reflux velocity(V)of the tricuspid valve was measured by continuous Doppler.According to Bernoulli equation,pulmonary arterial systolic pressure(PASP)was calculated.Three-dimensional echocardiography: The X5-1 probe was used to adjust the mode to 3D Full-volume.The three-dimensional images of four cardiac cycles on the standard apical four-chamber section were recorded at the end-expiratory holding state.The image was copied to TOMTEC workstation for offline analysis.The left ventricular cavity,right ventricular cavity and main pulmonary valve ring were marked respectively with the help of the software.The software automatically recognized the left ventricular end diastolic and left ventricular end systolic and automatically generated the right ventricular endocardial curve.Then we manually adjusted the region of interest to obtain the right ventricular end systolic volume(RVESV),right ventricular end diastolic volume(RVEDV),three-dimensional right ventricular ejection fraction(3D RVEF),right ventricular longitudinal strain(RVGLS),right ventricular free wall longitudinal strain(RVFLS).ROC curve analysis RVGLS was used to evaluate the diagnostic efficacy of right ventricular dysfunction in patients with CKD.Results: There was no significant difference in general data among the three groups(P> 0.05);there was also no significant difference in IVSTd,LVEF,RVFAC,PASP and TAPSE between the mild group and the normal group(P>0.05);compared with the normal group and the mild group,the IVSTd and PASP in the moderate-severe group were significantly higher,while the LVEF,RVFAC and TAPSE significantly lower(P< 0.05).Compared with the normal group,RVEDV and RVESV increased in the mild group,while 3D RVEF and RVFLS decreased but the results had no significant difference(P> 0.05),RVGLS was significantly lower(P<0.05);RVESV and RVESV(Figure 2)increased significantly in the moderate-severe group,while 3D RVEF,RVGLS and RVFLS decreased in the mild group(P<0.05).RVGLS was positively correlated with RVFAC and TAPSE in the CKD group(r = 0.483,0.523,P<0.05).ROG curve analysis of RVGLS was used to evaluate the diagnostic efficacy of right ventricular dysfunction in patients with CKD.When RVGLS was cut at 19.21%,its sensitivity was 87.6%,specificity was 79.4%,and the area under the curve was 0.801.Conclusion: Early cardiac function began to change in patients with chronic renal function without obvious clinical symptoms and indicators,but RVGLS showed impaired right ventricular function.As the course of uremia progresses,chronic renal function patients have moderate and advanced cardiac remodeling and hypertrophy,cardiac ejection fraction is reduced,while 3D RVEF,RVGLS and RVFLS decreased and cardiac function is moreimpaired.3D-STI technology can detect right ventricular function changes in patients with renal insufficiency in a convenient,accurate and real-time,providing valuable information for clinical treatment...