Echocardiographic Evaluation Of Left Ventricular Systolic And Diastolic Function And Related Factors In MHD Patients With Preserved Left Ventricular Ejection Fraction

Objective:1.Left ventricular diastolic and systolic function was evaluated by echocardiography in maintenance hemodialysis?MHD?patients with preserved left ventricular ejection fraction?LVEF?.2.To analyse correlative factor of the left ventricular diastolic dysfunction?DD?and systolic dysfunction?SD?in patients with MHD.Methods:Fifty patients with MHD in blood purification room as MHD group and 31healthy subjects as control group were collected.All the subjects were examined by echocardiography,electrocardiogram was connected synchronously,and offline analysis was performed by EchoPAC workstation.To analyse the influential factors of left ventricular DD and SD in MHD patients.The following indexes were measured by echocardiography:conventional ultrasound indexes,diastolic function indexes and systolic function indexes.Conventional echocardiography indexes:left ventricular end-diastolic diameter?LVEDD?,left ventricular end-systolic diameter?LVESD?,interventricular septal thickness?IVST?and posterior wall thickness?PWT?,left atrial anteroposterior diameter?LAD?,relative wall thickness?RWT?.Diastolic function indexes:early mitral diastolic forward flow velocity?E peak?,late diastolic forward flow veloc ity?A peak?,E/A,left atrial volume?LAV?,tricuspid regurgitation peak velocity?TRV?,the left atrial volume index?LAVI?,the early diastolic peak velocity?IVS-e,LAT-e?of mitral annular wall,the mean e'and E/e'.Systolic function indexes:left ventricular end-diastolic volume?LVEDV?,and left ventricular end-systolic volume?LVESV?,left ventricular ejection fraction?LVEF?,subendocardial myocardial circumference strain(CS_endo),middle myocardial circumference strain(CS_mid),epicardial myocardial circumference strain(CS_epi),radial strain?RS?,subendocardial longitudinal strain(LS_endo),middle myocardial longitudinal strain(LS_mid),epicardial myocardial longitudinal strain(LS_epi),global longitudinal strain?GLS?.According to the evaluation criteria of DD,MHD group was divided into NDD group and DD group.Results:1.Comparison between MHD group and control group:?1?Comparison of conventional ultrasound parameters:compared with control group,LVEDD,IVST,PWT,LVESD,RWT,LAD,LADI in MHD group increased,suggesting that the left ventricular diameter,myocardial thickness increased in MHD patients?P<0.05?.?2?Comparison of diastolic function parameters:LAVI,E/e',TVR increased in MHD group,and IVS-e,LAT-e was smaller in MHD group?P<0.05?,suggesting that the diastolic function of MHD patients was impaired?P<0.05?.?3?Comparison of systolic function parameters:LVEF was preserved in MHD group,but CS_endo,CS_mid,CS_epi,L S_endo,LS_mid,LS_epi,RS,GLS was decreased in MHD group,suggesting that LVEF was preserved,but myocardial systolic function might be in subclinical stage.2.NDD group and DD group:Compared with NDD group,LVEDD,IVST,PWT,LVESD,LAD,LAVI in was increased,suggesting that the change of cardiac cavity structure in DD patients was more obvious.There was no significant difference in LVEF and GLS between NDD group and DD group,suggesting that impaired diastolic function preceded decreased systolic function in MHD patients.3.Correlation analysis:In patients with MHD,E/e'was positively correlated with age and serum phosphorus levels?r=0.281,P=0.048;r=0.389,P=0.005?.GLS was related to systolic blood pressure,heart rate,creatinine level and hemoglobin content in MHD patients.GLS was positively correlated with systolic blood pressure,heart rate and creatinine?r=0.332,P=0.018;r=0.291,P=0.040;r=0.346,P=0.014?,and negatively correlated with hemoglobin content?r=-0.396,P=0.004?.Conclusion:Left ventricular systolic and diastolic function were impaired in MHD patients,although LVEF was preserved,suggesting early myocardial function was impaired.In addition,left ventricular systolic and diastolic function in MHD patients were related to blood phosphorus level,creatinine level,heart rate,anemia and blood pressure.The new technique of echocardiography could detect myocardial involvement in early stage and provide the basis for the choice of clinical treatment plan.