无创左室压力应变曲线评价血液透析对左室心肌做功的影响

Evaluation of left ventricular myocardial work in patients with maintenance hemodialysis using non-invasive left ventricular pressure-strain loops

目的采用无创左室压力应变曲线(pressure strain loops,PSLs)评价终末期肾脏疾病(end-stage renal disease,ESRD)患者在维持性血液透析(maintenance hemodialysis,MHD)后左室心肌做功的变化及单次血透对左室做功的影响。方法连续入组维持性血液透析≥6个月的ESRD患者92例,于非透析日采集患者二维长轴及短轴图像,其中28例患者在透析当天的透析前后30 min内再次采集图像。选取同期年龄、性别相匹配的健康志愿者40例为对照。采用PSLs进行脱机分析,获得左室整体做功指数(global work index,GWI)、整体有效功(global constructive work,GCW)、整体无效功(global wasted work,GWW)、整体做功效率(global work efficiency,GWE)及整体长轴应变(global longitudinal strain,GLS)。结果两组比较:MHD组GWE显著低于对照组(P<0.001),GWW显著高于对照组(P<0.001)。透析前后比较:透析后GWI(P<0.001)、GCW(P=0.002)、GWE(P=0.037)、GLS(P<0.001)均显著降低,GWW差异无统计学意义(P=0.892)。相关性研究结果:左室质量指数(left ventricular mass index,LVMI)与GWE、GWW、GLS具有相关性(GWE:r=‒0.546;GWW:r=0.438;GLS:r=0.559;P均<0.001)。MHD患者超滤量与透析前后GWI及GCW差值具有相关性(GWI差值:r=0.547,P=0.003;GCW差值:r=0.500,P=0.009)。结论PSLs结合后负荷和应变指标能敏感评估ESRD患者长期血液透析后心肌做功的改变及单次透析对心肌做功指标的影响。

Objective To evaluate the impact of single and longterm maintenance hemodialysis(MHD)on left ventricular myocardial work by non-invasive left ventricular pressure strain loops(PSLs).Methods Ninety-two MHD patients and 40 matched controls were enrolled in the study.Conventional echocardiography was performed on the non-dialysis day.Among them,28 MHD patients performed the echocardiography before and shortly after one hemodialysis session.Global longitudinal strain(GLS)and MW[Global work index(GWI),global constructive work(GCW),global work efficiency(GWE),global wasted work(GWW)]were estimated by left ventricle pressure strain curve.Results MHD patients performed a significantly reduced GWE(P<0.001)and elevated GWW(P<0.001)compared with healthy individuals.In 28 MHD patients,GWI(P<0.001),GCW(P=0.002),GWE(P=0.037)and GLS(P<0.001)were singnificantly reduced after one session of hemodialysis,while GWW(P=0.892)showed no statistical difference.Linear correlation analysis showed that left ventricular mass indes(LVMI)was correlated with GWE,GWW and GLS(GWE:r=‒0.546;GWW:r=0.438;GLS:r=0.559;P<0.001).Ultrafiltration volume was related with difference of GWI and GCW before and after hemodialysis(difference of GWI r=0.547,P=0.003;difference of GCW:r=0.500,P=0.009).Conclusion The non-invasive left ventricular pressure-strain loops combined with afterload and strain may be used to sensitively evaluate the myocardial work after long-term hemodialysis in ESRD Patients and the effect of one session of hemodialysis on myocardial work.