Evaluation Of The Left Ventricle Function In CKD Patients With Preserved Left Ventricular Ejection Fraction By 2D Speckle Tracking Imaging

Objective:This study used two-dimensional speckle tracking technology to evaluate the left ventricle function in CKD Patients with preserved left ventricular ejection fraction,and investigated the relationship between left ventricular structure and function and the severity of chronic kidney disease.Methods:CKD group:113 patients with chronic kidney disease were selected from the inpatient departments of the Second Affiliated Hospital of Nanchang University from January 2017 to November 2017.According to the 201 2 American Kidney Disease Foundation K/DOQI guidelines,patients were divided into three groups.The mild group(CKD stage 2):e GFR was 60-89ml/(min·1.73m~2),25 cases;the moderate group(CKD stage 3a&3b):eGFR was 30-59ml/(min·1.73m~2),28 cases;the severe Group(CKD stage 4&5):eGFR was?29 ml/(min·1.73 m~2),60 cases.In the normal control group,35 healthy volunteers with no organic disease were selected for the age and gender matched with the CKD group.They were no abnormalities in the ECG and echocardiographic examinations.All subjects were recorded for gender,age,height,weight,BMI,BSA,systolic blood pressure,diastolic blood pressure,serum creatinine,urea,eGFR,calcium,and phosphorus;conventional two-dimensional ultrasound was used to measure left atrial diameter at the end of systolic stage(LAESd),Left ventricular end-diastolic diameter(LVDd),left ventricular end-systolic diameter(LVSd),diastolic interventricular septum thickness(IVS),left ventricular posterior wall thickness(LVPW),calculated left ventricular mass index(LVMI),and relative wall thickness(RWT),biplanes Simpson's method for measuring left ventricular ejection fraction(LVEF),M-mode ultrasonography for measuring left ventricular fraction shortening(LVFS),and spectral Doppler for measuring the mitral valve of the diastolic blood Flow velocity(E)in the apical 4-chamber view,Tissue Doppler imaging(TDI)for measuring the early diastolic motion velocity e'at the mitral annular septum side and calculated the E/e.Apply 2D-STI to measure systolic global longitudinal strain(GLS),global radial strain(GRS),global circumferential strain(GCS).Measurement of apical 2-chamber view,apical 3-chamber view,apical 4-chamber view of left ventricular endocardium,myocardium,epicardial myocardial longitudinal strain and mitral level,papillary muscle level,apical level of left ventricular endocardium,middle myocardium,epicardial myocardial circumferential strain.Spearman correlation analysis was used to analyze the relationship between left ventricular structural and functional changes and the severity of chronic kidney disease.Results:(1)The systolic blood pressure in the severe CKD group was higher than that in the control group,mild group,and moderate group.Serum creatinine,urea nitrogen,and phosphorus in the severe CKD group increased compared with the mild and moderate groups.The body weight and body surface area of the severe CKD group were lower than those of the normal control group.The eGFR in the severe CKD group was lower than that in the mild group and the moderate group.The serum calcium in the severe CKD group was lower than that in the moderate group.The differences were statistically significant(P<0.05).The moderate CKD group had lower eGFR than the mild group,and the difference was statistically significant(P<0.05).There was no significant difference in age,height,BMI and DBP between groups(P>0.05).(2)In severe CKD group,LAESd,LVDd,IVS,LVPW,LVMI,and E/e increased compared with normal control group,mild group,and moderate group.The LVSd in the severe CKD group was increased compared with the control group.The RWT in the severe CKD group was increased compared with the control group and the mild group.e'in the severe CKD group was lower than that in the control group and the mild group.The differences were statistically significant(P<0.05).The IVS,LVMI,and E/e in the moderate CKD group increased compared with the control group.e'in the moderate CKD group was lower than that in the control group.The differences were statistically significant(P<0.05).E/e in the mild CKD group increased compared with the control group.The e'in the mild CKD group was lower than that in the control group.The differences were statistically significant(P<0.05).There was no significant difference in LVEF,LVFS,E between groups(P>0.05).(3)The GLS of severe CKD group was lower than that of normal control group,mild group,and moderate group.The GRS and GCS of the severe CKD group were lower than those of the normal control group and the mild group.The differences were statistically significant(P<0.05).The GLS and GCS in the moderate CKD group were lower than those in the normal control group.GRS in the moderate CKD group was lower than that in the control group and the mild group.The differences were statistically significant(P<0.05).The GLS of the mild CKD group was lower than that of the normal control group.The difference was statistically significant(P<0.05).The GRS and GCS of the mild CKD group had no significant change compared with the normal control group.The difference was not statistically significant(P>0.05).(4)In the severe CKD group,the endocardium and the middle myocardium of the apical two-chamber view,each layer of apical three-chamber view,the endocardium and the middle myocardium of the apical four-chamber view,myocardial longitudinal strains were decreased compared with the normal control group,mild group,moderate group.In the severe CKD group,the longitudinal strains of the epicardial layer at the apical two-chamber view and the epicardial layer at the apical four-chamber view were decreased compared with the normal control group and the mild group.The differences were statistically significant(P<0.05).In the middle CKD group,the longitudinal strains of the middle layer and the epicardial layer at the apical two-chamber view,the middle layer at the apical four-chamber view were reduced compared with the normal control group and the mild group.In the moderate CKD group,the longitudinal strains of the endocardium at the apical two-chamber view,each layer at the apical three-chamber view,and the endocardial and epicardial layers at the apical four-chamber view were lower than those in the normal control group.The differences were statistically significant(P<0.05).The longitudinal strain of the endocardial layer in each section of the mild CKD group was lower than that of the normal control group,and the difference was statistically significant(P<0.05).(5)In the severe CKD group,the circumferential strains of the endocardium and the middle layer at basal segment were decreased compared with the normal control group.In the severe CKD group,the circumferential strains of the middle and epicardial layers at middle segment,the endocardial layer at apical segment were reduced compared with the normal control group and the mild group.The circumferential strain of the endocardial layer at middle segment in the severe CKD group was lower than that of the normal control group,mild group,and moderate group.The above differences were statistically significant(P<0.05).The circumferential strain of the epicardial layer at middle segment in the middle CKD group was lower than that of the normal control group and the mild group,and the differences were statistically significant(P<0.05).There was no significant change in the circumferential strain of each layer myocardium at each level in the mild CKD group compared with the normal control group;the difference was not statistically significant(P>0.05).(6)Spearman correlation analysis showed that IVS,LVPW,LVMI,RWT,E/e were negatively correlated with eGFR,and e',GLS,GRS and GCS were positively correlated with eGFR.(7)GLS,GRS and GCS respectively were used to determine the early left ventricular systolic dysfunction in patients with CKD.When GLS was cut off at-19.57%,the sensitivity was the best,and the AUC and the Youden index were the highest.GRS and GCS have lower AUC,Youden index and sensitivity than GLS,and their specificity is slightly better than that of GLS.Conclusion:1.Early ventricular remodeling in patients with CKD did not change significantly.Patients with CKD had obvious left ventricular remodeling in the middle and late stages.Left ventricular diastolic dysfunction occurred early,and as the condition worsens,the more obvious about the left ventricular diastolic dysfunction.2.It found that the early systolic function of patients with CKD had been reduced;although at this moment the patient's left ventricular ejection fraction was in the normal range.Left ventricular systolic function in patients with CKD could be evaluated not only by global longitudinal,circumferential,and radial strains,but also by layered of left ventricular myocardial strain.The global longitudinal strain of left ventricular and longitudinal strain of the endothelium layer myocardial could find left ventricular systolic dysfunction at early stage,so as to provide clinical evidence for early intervention to reduce the occurrence of cardiovascular events in patients with CKD.