| Objective:To investigate the character of left ventricular longitudinal and circumferential maximum strain rate in patients with early chronic kidney disease(CKD) without hypertrophy configuration using velocity vector imaging(VVI) technique. To evaluate the regional myocardial function in CKD patients for their prevent and intervention early. Methods:The enrolled include 60 early CKD patients with stable renal function, and no left ventricular cavity enlargement or ventricular wall hypertrop, except the patients with secondary renal disease, for example, hyperten- sive nephrosclerosis, diabetic nephropathy, uric acidnephropathy, ect. Primary diseases included 42 cases with chronic glomerulonephritis, 6 cases with polycystic kidney, 5 cases c with hronic interstitial nephritis, 1 cases with renal artery stenosis and 1 cases with chronic pyelonephritis, 1 cases with renal tuberculosis and 1 cases with sponge kidney after resection of the left kidney. All patients were falled into two groups on the basis of LVMI and RWT: normal geometry(RWT≤0.42) group(group A) 30 cases, male 18 and female 12, age 32-65 years(average 46.1+10.8 years); concentric remodeling(RWT>0.42) group(group B) 30 cases, male 17 and female 13, age 21-62 years(average 44.7+9.8 years). 30 cases of healthy subjects were selected as control group(group C), male 20 and female 10, age 25-60 years(average 44.4+8.5 years).Siemens Sequoia 512 equipment and VVI sofeware were used,the probe frequency is 2.0-4.0MHz.The left ventricular internal dimension in diastole(LVIDd), left ventricular posterior wall thickness(LVPWT),interventricular sepal thickness(IVST), diastolic mitral flow spectrum E and A ratio(E/A), left ventricular ejection fraction(LVEF) were determined by conventional echocardiography. The longitudinal systolic maximum strain rate(SSRLMAX) and longitudinal early and end diastolic maximum strain rate(DSRLMAX/e, DSRLMAX/n) of left ventricular long axis and circumferential systolic maximum strain rate(SSRCMAX), circumferential early and end diastolic maximum strain rate(DSRCMAX/e,DSRCMAX/n) of short-axis view were determined by VVI. Results:1. There were no significant difference in age, gender, heart rate, body mass index among three groups(P>0.05). The e GFR was significantly lower and ether RWT or LVMI was significantly higher in Group A than that in group C(P<0.05); The e GFR was significantly lower and ether RWT or LVMI was significantly higher in Group B than that in group C and group A(P<0.05). The E/A value was lower in group B than that in group C and group A(P<0.05), but there was no significant difference between group A and C(P>0.05). There was no statistical significance in LVEF among three groups(P>0.05).2. A negative correlation was showed between ether RWT or LVMI and e GFR(P<0.01), the regression equation were RWT(Y1)=-0.004x+0.760 and LVMI(Y2)=-0.170X+107.2723. The SSRLMAX of middle segment was lower in group B than that of group A and group C(P<0.05), the other segments have no significant difference(P>0.05).4. The DSRLMAX/e of basal segment and middle segment was lower in group B than that of group A and group C(P<0.05). The DSRLMAX/e of middle segment was lower in group A than that of group C(P<0.05). There was no difference of DSRLMAX/e in apex segment among three groups(P>0.05). There was no difference of DSRLMAX/n among three groups(P>0.05).5. There were no differences in SSRCMAX, DSRCMAX/, and DSRCMAX/a of the basal, middle and apical segments among three groups(P>0.05).6. The SSRMAX of basal segment and middle segment of intervals were lower in group B than that in group C and group A(P<0.05). the other segments have no significant difference(P>0.05).7. The DSRMAX/e of each segmental of intervals and posterior wall was lower in group B than that in group C and group A(P<0.05). In group A, DSRMAX/e only of each segmental of intervals was lower than that in group C(P<0.05) and the other segments have no significant difference(P>0.05). DSRMAX/n had no statistical significance among three groups(P>0.05).8. The longitudinal and circumferential strain rate curv of left ventricular myocardium in early CKD patients were similar with the normal person, but the myocardial maximum strain rate had a decrese in some segments. Conclusions:1. Although the LVMI was normal in early CKD patients with normal left ventricular configuration and centripetal reconstruction,But still higher than that of the control group and showed an increasing trend, It was indicated that left ventricular remodeling has already occurred in early chronic kidney disease.2. There was a significantly negative correlation in e GFR with RWT or LVMI(P<0.01). With the decline in the level of e GFR, LVMI and RWT increased. This showed that the degree of left ventricular remodeling was associated with levels of e GFR.3. The longitudinal maximum strain rate of basal segment and middle segment decreased in CKD patients, while the circumferential maximum strain rate showed no significant difference. This may sugested that the longitudinal maximum strain rate could be more earlier to reflect the left ventricular myocardial systolic function changes.4. The longitudinal maximum strain rate of basal segment and middle segment dicresed in CKD patients,while that of apical segment showed no significant difference. This may be related to left ventricular myocardial fiber composition and its arrangement related characteristics.5. The diastolic dysfunction apeared earlier than the systolic dysfunction in CKD patients. Separate application of E/A ratio to evaluate left ventricular diastolic function is not accurate..The VVI technique can be observed earlier regional myocardial diastolicfunction damage.6. Because of different segments of left ventricularmyocardial has different load, The left ventricular remodeling of each segment in the patients with early CKD is not synchronization. In the heart of the overall coordination of the movement,the particular segment would has the main or minor role in particular phase of motion of left ventricular myocardium. |
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