自体动静脉内瘘建立对尿毒症患者左心室心肌功能的影响

Effect of establishing arteriovenous fistula on left ventricular myocardial function in uremic patients

目的应用二维斑点追踪技术(two dimension-speckle tracking imaging,2D-STI)及无创性左室压力-应变环技术观察评价终末期肾病(end-stage renal disease,ESRD)患者自体动静脉内瘘(autogenous arteriovenous fistula,AVF)建立早期左心室心肌功能的变化。方法选取2022年10月1日至2023年3月31日在苏北人民医院肾内科拟行AVF手术的ESRD患者55例。分别于术前1周、术后1 d、术后6周行超声心动图检查,比较AVF术前后不同时间点的左心室整体纵向应变(global longitudinal strain,GLS)及心肌做功(myocardial work,MW)参数变化,分析MW参数中整体做功效率(global work efficiency,GWE)、整体做功指数(global work index,GWI)、整体无用功(global wasted work,GWW)、整体有用功(global constructive work,GCW)与GLS的敏感性、相关性。结果ESRD患者AVF术后1 d,GWE(P=0.025)、GLS绝对值(P<0.001)升高,GWW(P=0.041)降低。术后6周GWI(P=0.003,P=0.001)、GWE(P=0.005,P<0.001)、GLS绝对值(P=0.026,P<0.001)较术前1周、术后1 d均降低,GWW(P<0.001,P<0.001)升高,同时GLS评估其左室功能受损的受试者工作特征曲线下面积为0.607,小于GWI、GWW、GWE的0.607、0.612、0.657、0.618。相关性分析显示,GLS与GWI、GCW、GWE呈负相关(r=-0.629;r=-0.574;r=-0.659;均P<0.05),与GWW呈正相关(r=0.418;P<0.05)。结论ESRD患者左心室心肌功能在AVF建立初会短暂的增强,一段时间后,则受损减低。与2D-STI及左室射血分数相比,无创性左室压力-应变环技术可以有效评估ESRD患者AVF建立早期左心室心肌功能变化。

Objective To employ two dimensional speckle tracking imaging(2D-STI)and noninvasive left ventricular pressure-strain loop for observing and evaluating the changes of left ventricular myocardial function of patients with end-stage renal disease(ESRD)during early establishment of autogenous arteriovenous fistula(AVF).Methods A total of 55 ESRD patients who were to undergo AVF surgery in the Department of Nephrology,Subei People’s Hospital from October 1,2022 to March 31,2023 were selected.Echocardiography was performed at Week 1 pre-operation,Day 1 post-operation and Week 6 post-operation.The changes of global longitudinal strain(GLS)and myocardial work(MW)were compared at different timepoints pre/post-AVF.Sensitivity and correlation of myocardial work(MW)were examined for global work efficiency(GWE),global work index(GWI),global wasted work(GWW),global constructive work(GCW)and global longitudinal strain(GLS).Results Absolute values of GWE(P=0.025)and GLS(P<0.001)rose and GWW(P=0.041)declined at Day 1 post-AVF.Absolute values of GWI(P=0.003,P=0.001),GWE(P=0.005,P<0.001)and GLS(P=0.026,P<0.001)at Week 6 post-operation were lower than those at Week 1 pre-operation and Day 1 post-operation while GWW rose(P<0.001,P<0.001).Meanwhile area under ROC curve of GLS was 0.607.It was smaller than that of GWI/GWW/GWE(0.612,0.657&0.618).Correlation analysis indicated that GLS was correlated negatively with GWI/GCW/GWE(r=−0.629;r=−0.574;r=−0.659;all P<0.05)and positively with GWW(r=0.418;P<0.05).Conclusion In ESRD patients,left ventricular myocardial function becomes transiently elevated at the start of AVF establishment.After some time,impairment is lessened.As compared with 2D-STI/LVEF,non-invasive LVPSL may effectively evaluate the changes of left ventricular myocardial function during early AVF establishment in ESRD patients.