Evaluation Of Changes In Carotid Stiffness And Left Ventricular In Hemodialysis Patients With End-Stage Renal Disease With Hyperparathyroidism By Ultrasound

BackgroundPatients who have end-stage renal disease undergoing hemodialysis has the common complication which is cardiovascular events,and secondary hyperparathyroidism is the most common complication.The increase of plasma parathyroid hormone will lead to intracellular calcium ion overload,oxidative stress induction of vascular smooth muscle,and pathological remodeling of cardiovascular system.Atherosclerosis is an independent risk factor as the prediction of cardiovascular events,monitoring cardiovascular changes in such patients provides an important reference for the prevention and early intervention of related cardiovascular events.ObjectiveThe changes of carotid artery and left ventricular function in hemodialysis patients with end-stage renal disease complicated with hyperparathyroidism were evaluated by ultrafast ultrasound pulse wave velocity and 2D speckle traking imaging.MethodsThirty patients with end-stage renal disease complicated with hyperparathyroidism who underwent hemodialysis in the blood purification center of our hospital from March 2018 to December 2018 were selected and underwent carotid artery and echocardiography after hemodialysis.Carotid artery IMT,PSV,EDV,TAPV,TAMV,PG,MG and cardiac IVSd,LVPWd,LVIDd,LVIDs and LVEF were routinely measured.Initial of systole(PWV-BS)and end of systole(PWV-ES)and their respective standard deviations were measured by the extreme pulse imaging.The cardiac dynamic images of three cardiac cycles were collected.EchoPAC203 ultrasound workstation conducted image analysis and obtained the global constructive work(GCW),global wasted work(GWW)and global myocardial work efficiency(GWE)of the left ventricle.The data of carotid artery and heart in hemodialysis patients with end-stage renal disease complicated with hyperparathyroidism were analyzed statistically.Results1.The ultrafast pulse wave technique can quantitatively evaluate the changes in carotid artery stiffness in patients with end-stage renal disease complicated with hyperparathyroidism in hemodialysis,providing an important information for the prevention and early intervention of cardiovascular events.2.Compared with the control group,both PWV-BS and PWV-ES in MHD group were significantly increased,with statistically significant differences(P<0.05),and PWV-ES was more significantly increased than PWV-BS.3.Compared with the healthy control group,the systolic peak flow rate(PSV),end-diastolic flow rate(EDV),time-average peak flow rate(TAPV),time-average flow rate(TAMV),peak pressure difference(PG)and average pressure difference(MG)of the MHD group were all lower than those of the normal control group,with statistically significant differences(P<0.05).4.Compared with the control group,the PSD and GWW of MHD group increased(P<0.05).GLS and GWE decreased in MHD group(P<0.05).There was no significant difference in GCW and GWI(P>0.05).5.PWV-BS and PWV-ES of MHD group were negatively correlated with GCW and GWE,and positively correlated with GWW.Conclusions1.The rapid pulse wave technique can quantitatively evaluate the changes in carotid artery stiffness in patients with end-stage renal disease complicated with hyperparathyroidism in hemodialysis,providing an important information for the prevention and early intervention of cardiovascular events.2.The myocardial work parameters based on two-dimensional speckle tracking technology can be used to noninvasively analyze the early changes of myocardial mechanics in patients with end-stage renal disease complicated with hyperparathyroidism in hemodialysis,which has certain clinical application value.3.Hemodialysis patients with end-stage renal disease complicated by hyperparathyroidism,with the increase of carotid artery stiffness,the increase of global wasted work,and the decrease of global constructive work and global work effificiency.