分层应变参数评价动静脉内瘘术对尿毒症患者左室收缩功能的早期影响

Early effects of arteriovenous fistulas on left ventricular systolic function in uremia patients evaluated by layer-specific speckle tracking imaging

目的:运用分层斑点追踪成像(LSTI)技术评价动静脉内瘘(AVF)术对尿毒症患者左室收缩功能的早期影响。方法:经临床确诊为尿毒症的患者34例为病例组,分别于AVF术前1 d和术后1周行超声心动图检查,选取性别、年龄相匹配的健康志愿者34例作为对照组。获取常规超声心动图参数,运用LSTI技术获取心肌分层应变参数(LS-endo、LS-mid、LS-epi),并计算心内膜下与心外膜下心肌纵向应变跨壁梯度(ΔGLSendo-epi)及室壁厚度标化的左室应变跨壁梯度(S-ΔGLSendo-epi)。结果:各组心肌分层应变参数LS-endo、LS-mid、LS-epi均从内向外呈递减趋势;与对照组相比,病例组患者LS-endo、LS-mid、LS-epi、ΔGLSendo-epi、S-ΔGLSendo-epi均显著降低(均为P<0.01);与AVF术前比较,病例组患者术后LS-endo、LS-mid、ΔGLSendo-epi、S-ΔGLSendo-epi降低(均为P<0.05),LS-epi在AVF术前后无统计学差异(P>0.05)。结论:LSTI技术可用于定期监测尿毒症患者AVF术后左室收缩功能;AVF建立早期可造成左室心肌纵向应变减低,LS-endo或可成为监测AVF相关心脏损伤的敏感指标。

Objective: To evaluate the early effects of arteriovenous fistulas(AVF) on left ventricular systolic function in patients with uremia by layer specific speckle tracking imaging(LSTI).Methods: Thirtyfour patients with uremia and 34 matched controls were enrolled in this study. Echocardiography were performed on patients one day before and one week after AVF, as well as on controls. Conventional echocardiography and strain parameters(LS-endo, LS-mid, and LS-epi)are obtained. The transmural gradient of GLS(ΔGLSendo-epi) and standardized ΔGLSendo-epi by mean wall thickness of left ventricle were calculated.Results: LS-endo, LS-mid and LS-epi of each group showed a decreasing trend from inside to outside. LS-endo, LS-mid, LS-epi, ΔGLSendo-epi, and S-ΔGLSendo-epi were significantly lower in uremia group than those in control group(all P<0. 01). LS-endo, LS-mid,ΔGLSendo-epi, and S-ΔGLSendo-epi were reduced(all P<0. 05) after AVF, while LS-epi showed no significant difference before and after AVF(P>0. 05).Conclusion: LSTI can be used to regularly monitor left ventricular systolic function in uremia patients after AVF. AVF may have effects on the longitudinal strain of left ventricular. LS-endo may be a sensitive indicator for AVF-related cardiac injury.