Evaluation Of Ventricular Function In Patients With Secondary Hyperparathyroidism By Three-dimensional Quantitative Ultrasound

Objective:1.Application of Three-dimensional Quantitative Ultrasound to evaluate left ventricular myocardial strain and movement synchronization in patients with secondary hyperparathyroidism;2.To explore the predictive value of the right ventricular Tei index combined with plasma B-type natriuretic peptide(BNP)and tricuspid annulus systolic displacement(TAPSE)in patients with secondary hyperparathyroidism of right heart insufficiency before and after treatment with cinacalcet.Methods:1.Collected 150 patients whom underwent maintenance dialysis in the hemodialysis room with the diagnosion of SHPT,divided them into three subgroups,subgroup A(300-600pg/m L),subgroup B(601-900pg/m L),subgroup C(above 901pg/m L),and 50 healthy volunteers were selected for the control group.All participants underwent conventional echocardiography,three-dimensional speckle tracking image(3DSTI),and real-time three-dimensional echocardiography(RT-3DE).The globa longitudinal strain(GLS),globa area strain(GAS),globa circumferential strain(GCS)and global radial strain(GRS)were obtained by3D-STI;The minimum volume point time Tmsv 16-SD(ms),Tmsv 16-Dif(ms),Tmsv 16-SD/RR(%)and Tmsv 16-Dif/RR(%)were obtained by RT-3DE.The ultrasound parameters were all tested for repeatability;2.167 patients in the case group and 150 patients in the control group were measured and calculated by tissue Doppler imaging(TDI)and calculated the right ventricular Tei index(RV-Tei),and the M-mode mode was used to measure the tricuspid annulus systolic displacement(TAPSE)).In the case group,the early morning blood was drawn within 24 hours of admission to complete the determination of plasma B-type natriuretic peptide(BNP)and PTH.Patients in the case group were only treated with cinacalcet.TDI and two-dimensional M-mode ultrasound were performed 12 weeks later to obtain the above parameters,and the above indicators were obtained through laboratory examinations.The data obtained before the treatment with cinacalcet was grouped into group a,and all the data after the treatment were grouped into group b.Groups a and b were compared with the control group to find the differences of each parameter.Logistic analysis was used to analyze the independent risk factors of right heart insufficiency in patients in groups a and b.The effects of each parameter in groups a and b on patients were evaluated by ROC curve.Repeatability test of the above ultrasound parameters.Results:1.Compared with the control group,all the three-dimensional strain parameters of the case group were significantly reduced(P<0.05).Comparing the subgroups,as the PTH level in the group increased,each strain parameter was only GAS It showed a decreasing trend(P<0.05),and there was no statistical difference among other strain parameters.The ROC curve shows that the area under the curve(AUC)of GLS,GCS,GRS and GAS are 0.671,0.573,0.533 and 0.585,GLS=-19.5 is the cut-off value for diagnosing left ventricular systolic dysfunction.,the sensitivity is 77.5%,the specificity is 83.2%,the 95% confidence interval is 0.537-0.815,and the Youden index is 0.383;Compared with the control group,the left ventricular Tei index of the A subgroup,the B subgroup and the C subgroup increased in sequence,and the LVEF decreased in sequence,and the difference was statistically significant(P<0.05).Compared with the A subgroup,the left ventricular Tei index of the C subgroup increased(P < 0.05),and the LVEF of the B subgroup and the C subgroup decreased successively,and the difference was statistically significant(all P<0.05);2.Compared with the control group,Tmsv16-SD(ms),Tmsv 16-Dif(ms),Tmsv 16-SD/RR(%)and Tmsv16-Dif/RR(%)of the case group were significantly prolonged(P<0.05)).In the comparison between subgroups,as the PTH level of the group increased,all synchronization parameters showed a prolonged;3.Pearson’s correlation analysis showed that only GAS was significantly negatively correlated with PTH among the four strain parameters(r=0.503,P < 0.01)and the remaining parameters had no significant correlation with PTH levels;The repeatability test results show that the correlation coefficient(Rho)of 3DSTI parameters is between 0.737 and 0.844,and the Rho range of RT-3DE parameters is between 0.754 and0.893,indicating that the above parameters have good repeatability.The repeatability test of TAPSE and RVTei within and between observers,Alpha coefficients are both>0.9,and ICC are both>0.75,showed high repeatability and reliability;4.The results before and after treatment with cinacalcet showed that compared with the control group,RVTei and BNP of group a increased,TAPSE decreased(P<0.05),and the RV-Tei of group b increased(P<0.05),there was no statistically significant difference in TAPSE,BNP and PTH(all P>0.05);5.ROC curve showed that the AUC of TAPSE,BNP,RV-Tei and PTH of group a were all> 0.600(all P<0.05),the AUC of TAPSE was 0.873,and the best predictive value was 8.25 mm.The area under the RVTei curve in group b was 0.817,and the best predictive value was 0.29.The area under the curve of TAPSE,BNP and PTH were all> 0.500(all P <0.05).Logistic regression analysis results showed: BNP(OR=4.992,P=0.019)and PTH(OR=5.404,P=0.015)in group a,independent risk factor of RVD.RV-Tei in group b(OR=6.495,P=0.013)was an independent risk factor for RVD;Conclusions:1.Three-dimensional quantitative echocardiography(3D-STI and RT-3DE)shows good value in the evaluation of the left ventricular strain and synchronization of SHPT patients.The change of 3D-STI parameters compared with the control group indicates that the deformability of the left ventricle of SHPT patients is lower than that of normal people,and the overall area strain(GAS)is more sensitive and specific than other strain parameters;The time parameters measured by RT-3DE reflects the asynchrony of left ventricular movement in SHPT patients;2.RV-Tei,TAPSE,BNP and PTH have certain reference value for SHPT patients with right heart insufficiency.According to experiments,the indicators that SHPT patients should pay attention to before and after treatment with cinacalcet are different.The TAPSE before treatment is of good value for evaluating the right heart function of the patient.After treatment,attention should be paid to the patient’s RV-Tei to evaluate the right heart function of the patient.