二维斑点追踪成像技术评价尿毒症患者左室心肌功能

Assessment of left ventricular myocardial function using two dimensional speckle tracking echocardiography in uremic patients

目的应用二维斑点追踪技术定量评价血液透析(简称血透)前及维持性血透尿毒症患者的左室运动及应变功能。方法选取本院维持性血透(血透组)及行血透前准备的尿毒症患者(透前组)各15例;另选取15名健康者为对照组,分别测量左室各节段纵向、圆周及径向的收缩期峰值速度(Vs)和舒张早期峰值速度(Ve)、收缩期峰值应变(ε)。结果 3组间左室射血分数(LVEF)差异无统计学意义。透前组和血透组的纵向基底段及中间段Vs及Ve均较对照组显著降低[基底段Vs分别为(4.36±1.24)cm/s、(5.20±1.78)cm/s、(6.12±2.63)cm/s;中间段Vs分别为(4.00±1.34)cm/s、(4.16±1.48)cm/s、(4.79±1.61)cm/s],透前组Vs降低更明显。圆周及径向运动速度指标在3组间差异无统计学意义。透前组和血透组纵向ε均较对照组显著降低,圆周及径向ε仅透前组降低。结论尽管LVEF正常,尿毒症患者的左室局部运动和应变功能仍受损,维持性血透可能部分改善心肌功能。

Objective To evaluate left ventricular（LV） regional myocardial function of uremic patients who were prepared for hemodialysis or during the maintenance hemodialysis by two dimensional speckle tracking echocardiography.Methods The study included 15 maintenance hemodialysis patients（hemodialysis group）,15 uremic patients hospitalized for creating the arteriovenous fistula（non-dialysis group）,and 15 healthy volunteers（control group）.Speckle tracking echocardiography was performed.LV regional longitudinal,circumferential and radial peak systolic velocity（Vs）,peak early diastolic velocity（Ve）,and peak systolic strain（ε） were measured,respectively.Results Left ventricular ejection fraction（LVEF） was similar among the three groups.However,both hemodialysis and non-dialysis groups had lower longitudinal Vs and Ve in LV basal segment and middle segment as compared with the control group [Vs in basal segment（4.36±1.24） cm/s,（5.20±1.78） cm/s,and（6.12±2.63） cm/s;Vs in middle segment（4.00±1.34） cm/s,（4.16±1.48） cm/s,and（4.79±1.61） cm/s,respectively）.Moreover,Vs in non-dialysis group was lower than that in hemodialysis group.The circumferential and radial velocity parameters showed no significant difference among the three groups.Longitudinal peak systolic strain in hemodialysis and non-dialysis groups was also decreased as compared with controls;however,decreased circumferential and radial peak systolic strain was only found in non-dialysis group.Conclusion LV regional myocardial movement and strain are impaired in uremic patients even with normal LVEF.Maintenance hemodialysis might somewhat contribute to functional improvement.