3D-STI Evaluates The Effect Of Arteriovenous Fistula On The Left Ventricular Systolic Function In Patients With Uremia

Background Uremia is the end-stage of chronic kidney dysfunction(CKD).The main cause of morbidity and death in CKD patients is cardiovascular disease,and left heart failure is the main cause of cardiovascular disease.Therefore,early detection of abnormal left heart function in uremia patients is of great significance for the prognosis of uremia patients.Hemodialysis(HD)is one of the most effective means for patients with end-stage renal disease.Arteriovenous fistula(AVF)provides a long-term and effective vascular access for hemodialysis.The current domestic and foreign research results evaluating the effect of AVF on left ventricular function in patients with uremia are all based on conventional echocardiography,which is insensitive to the changes of left ventricular systolic function in the early stage after AVF,and there are few studies comparing the left ventricular function before and after AVF.Therefore,in order to provide an effective means to prompt early heart failure and clinical evaluation of therapeutic effect,this study uses three-dimensional speckle-tracking echocardiography(3D-STI)to study the effects on left ventricular systolic function of uremia patients before and after AVF,and whether the indexes changed with the time of AVF.Objective To use 3D-STI evaluates the effect of arteriovenous fistula on the left ventricular systolic function in patients with uremia.Methods A total of 41 patients with uremia who met the criteria and needed to undergo fistula(internal forearm fistula)were included.Each index was measured respectively before AVF,1 day,1 month and 3months after AVF.General clinical data such as age,sex,height,weight,blood pressure and heart rate were collected,and brachial artery flow before AVF,and1 day,1 month and 3 months after AVF were recorded.The differences of conventional echocardiographic indexes and 3D-STI indexes including left ventricular global longitudinal strain(LVGLS),left ventricular global circumferential strain(LVGCS),left ventricular global area strain(LVGAS),left ventricular global radial strain(LVGRS),left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV)before AVF,and 1 day,1 month and 3 months after AVF were compared respectively.The correlation between brachial artery flow change,fistula diameter and left ventricular strain change of3D-STI was analyzed at 1 day after AVF.To explore whether 3D-STI before and after AVF is more sensitive than conventional echocardiography in evaluating left ventricular systolic function in uremic patients.Results(1)The systolic blood pressure,diastolic blood pressure and heart rate at 1 day after AVF was significantly different from those before AVF(P < 0.05).The systolic blood pressure at 1 months after AVF was significantly different from that before AVF(P < 0.05).There was no significant differences in systolic blood pressure at 3 months after AVF(P <0.05).There were no significant differences in diastolic blood pressure and heart rate at 1months and 3 months after AVF(P < 0.05).(2)Conventional echocardiography showed that the left ventricular ejection fraction(LVEF),an index reflecting left ventricular systolic function,had no significant differences at 1 day,1 month and 3 months after AVF compared with that before AVF(P < 0.05).The E,A at 1 day after AVF were statistically significant compared with those before AVF(P < 0.05),but the E,A at 1 month and 3 months after AVF were not statistically significant compared with those before AVF(P < 0.05).LVDD and LVMI at 1 day after AVF were not significantly different from those before AVF(P < 0.05).LVDD and LVMI at 1 month and 3 months after AVF were significantly different from those before AVF(P < 0.05).There were no significant differences in IVS,LVPWD,E/A at 1 day,1month and 3 months after AVF compared with those before AVF(P < 0.05).(3)TDI showed that there was no significant difference in Sm,Em,Am,Em/Am and E/Em at 1 day,1 month and 3 months after AVF compared with those before AVF(P < 0.05).(4)3D-STI showed that LVGLS,LVGCS,LVGAS and LVGRS,which reflect the left ventricular systolic function,were significantly different at 1 day after AVF compared with before AVF(P < 0.05),and significantly decreased at 1 day after AVF compared with before AVF,but had no significant differences at 1 month and 3 months after AVF compared with before AVF(P < 0.05).LVEDV and LVESV at 1 day,1 month and 3 months after AVF were significantly different from those before AVF(P < 0.05).(5)The intra-observer consistency of the 3D-STI strain values LGLLS,LVCCS,LVGRS,and LVGAS is relatively high.(6)Pearson correlation analysis results showed that brachial artery flow at 1 day after AVF was positively correlated with LVGLS(r=0.34,P < 0.05),while brachial artery flow at 1 day after AVF was not correlated with LVGCS,LVGAS and LVGRS(r=0.23,0.27,-0.22,P > 0.05).There was no correlation between fistula diameter and LVGLS,LVGCS,LVGAS and LVGRS(r=0.09,-0.03,0.00,0.10,P > 0.05).(7)Receiver operating curve(ROC)analysis showed that the area under the curve of LVGLS was 0.727(P < 0.001,95%CI 0.61-0.84).With LVGLS=-11.5% as the cut-off value,the sensitivity and specificity of LVGLS in predicting early left ventricular systolic function after AVF were 78% and 68%.Conclusion(1)3D-STI is more sensitive than conventional echocardiography in early assessment of left ventricular systolic function in patients with uremia at 1 day after AVF,and LVGLS can be a sensitive index for early detection of myocardial function after AVF.(2)The greater the change in brachial artery flow at 1 day after AVF,the greater the effect on left ventricular systolic function in uremic patients.