峰值应变离散度评价维持性血液透析患者左心室收缩同步性

Peak strain dispersion in evaluation of left ventricular systolic synchronicity of maintenance hemodialysis patients

目的探讨左心室纵向峰值应变离散度(PSD)评价维持性血液透析(MHD)患者左心室收缩同步性的价值。方法收集38例MHD患者(MHD组)和45名正常志愿者(对照组),采集心尖二腔、三腔及四腔3个长轴切面连续3个心动周期的二维灰阶动态图像,计算左心室18节段纵向应变达峰时间的标准差(PSD);比较两组间PSD差异,并评价PSD与各参数间的相关性。结果MHD组PSD[(54.21±11.55)ms]高于对照组[(35.58±14.37)ms;t=4.653,P<0.001]。MHD组PSD与左心室质量指数(LVMI)、室间隔舒张末期厚度(IVSd)、左心室后壁舒张末期厚度(LVPWd)、左心室舒张末期内径(LVDd)、左心室收缩末期容积(LVESV)、左心室舒张末期容积(LVEDV)均呈正相关(r=0.461、0.466、0.498、0.472、0.414、0.498,P均<0.05)。结论 MHD患者早期即可出现左心室收缩同步性下降;PSD可早期、定量评价左心室收缩同步性。

Objective To investigate the value of peak strain dispersion （PSD） in evaluation of synchronicity of left ventricle in maintenance hemodialysis （MHD） patients. Methods Totally 38 MHD patients （MHD group） and 45 healthy volunteers （control group） were enrolled. Two-dimensional dynamic images, including standard apical two-chamber, long-axis and four-chamber views in 3 consecutive cardiac cycles were acquired, and the standard deviation of time-to-peak longitudinal strain, i.e. PSD, in 18 segments of left ventricle were calculated. The difference of PSD between the two groups and the correlation between PSD and other parameters were assessed. Results PSD of MHD group （[54.21±11.55] ms） was larger than that of control group （[35.58±14.37]ms; t=4.653, P 〈 0.001）. In MHD group, PSD had positive correlation with left ventricular mass index （LVMI）, interventricular septum thickness at end-systolic （IVSd）, left ventricular posterior wall thickness at end-diastolic （LVPWd）, left ventricular end-diastolic diameter （LVDd）, left ventricular end-systolic volume （LVESV） and left ventricular end-diastolic volume （LVEDV; r=0.461, 0.466, 0.498, 0.472, 0.414, 0.498, respectively, all P〈0.05）. Conclusion Left ventricular systolic synchronicity in MHD patients might be impaired in early stage, which can be quantitatively evaluated with PSD.