应用心肌分层应变及做功技术评估长期腹膜透析尿毒症患者左心室功能

Evaluation of left ventricular function in uremic patients undergoing long-term peritoneal dialysis by myocardium layer-specific strain and myocardial work

目的:利用心肌分层应变及心肌做功技术对长期腹膜透析的尿毒症患者的左心室功能进行研究,评估其在长期腹膜透析下的心功能变化。方法:选择长期规律进行腹膜透析且经常规超声心动图检查提示左心室射血分数(left ventricular ejection fraction,LVEF)正常的尿毒症患者14例,测量其常规二维超声心动图参数,利用二维斑点追踪及心肌分层应变技术测量左心室整体纵向收缩期峰值应变(global longitudinal peak systolic strain,GLS)及内膜层、肌层和心外膜层3层心肌的纵向收缩期峰值应变(longitudinal peak systolic strain,LS),并结合血压得出左心室心肌整体做功参数,共同评估左心室心肌功能,随访5年并比较腹膜透析5年前后相关数据变化。结果:规律腹膜透析5年后,尿毒症患者LVEF改变无统计学差异;GLS在四腔心切面明显减低(P=0.018),并从心内膜减低至心外膜(LS心内膜层P=0.029,LS肌层P=0.017,LS心外膜层P=0.004);心肌整体做功参数以整体无用功(GWW)升高为主(P=0.048),整体有用功(GCW)、整体做功指数(GWI)及整体做功效率(GWE)无统计学差异。结论:长期规律腹膜透析5年的尿毒症患者,其左心室整体心肌功能尚保持稳定,但局部心肌收缩功能进一步受损,主要体现在后间隔和侧壁的各层心肌,心肌做功以GWW升高为主。

Objective:To describe the left ventricular function of uremia patients with long-term peritoneal dialysis by application of myocardial layer-specific strain analysis and myocardial work techniques,and to evaluate the changes of myocardial function under long-term peritoneal dialysis.Methods:A total of 14 patients with uremia who underwent peritoneal dialysis regularly and whose left ventricular ejection fraction(LVEF)was normal by routine echocardiography were enrolled in the study.Routine two-dimensional echocardiographic parameters were measured.Left ventricular global longitudinal peak systolic strain(GLS)and the longitudinal peak systolic strain(LS)of the endocardium(LS endo),myocardium(LS myo)and epicardium(LS epi)were measured by two-dimensional speckle tracking imaging(2D-STI)and myocardial layer-specific strain analysis.Combined with blood pressure,the overall work parameters of the left ventricular myocardium were obtained to jointly evaluate the myocardial function of the left ventricle.The patients were followed up for 5 years and compared before and after 5 years of peritoneal dialysis.Results:After 5 years of regular peritoneal dialysis,there was no statistical difference in the change of LVEF in uremia patients,GLS significantly decreased in the four-chamber plane of the heart(P=0.018),and decreased from endocardium to epicardium(LS endo P=0.029,LS myo P=0.017,LS epi P=0.004);global work parameters were mainly increased in global wasted work(GWW,P=0.048),but there were no significant differences in global constructive work(GCW),global work index(GWI)and global work efficiency(GWE).Conclusion:In uremia patients with long-term regular peritoneal dialysis for 5 years,the overall myocardial function of the left ventricle remained stable,but the local myocardial systolic function was further impaired,mainly evidenced by decrease of the myocardium of the posterior septum and lateral wall,and the myocardial work was dominated by elevated GWW.