Peak strain dispersion and global longitudinal peak strain for evaluating left ventricular function and systolic synchrony in patients with end-stage renal disease receiving different replacement therapies

doi:10.3877/cma.j.issn.1672-6448.2021.03.004

Abstract

Abstract:

Objective

To evaluate the value of peak strain dispersion (PSD) and global longitudinal peak strain (GLPS) in evaluating left ventricular global longitudinal systolic function and left ventricular systolic synchrony in patients with end-stage renal disease (ESRD) receiving different replacement therapies.

Methods

Eighty-nine patients with ESRD who were treated at the First Affiliated Hospital, College of Medicine, Zhejiang University from July to October 2018 were divided into three groups according to the replacement therapy used: kidney transplantation group (n=30), hemodialysis group (n=31), and peritoneal dialysis group (n=28). Meanwhile, 33 heathy adults were selected as a control group. Two dimensional gray-scale dynamic images of apical two chamber view, three chamber view, and four chamber view were collected for three consecutive cardiac cycles. The longitudinal peak contraction strain curve and the time to peak longitudinal strain bull's eye plot of the left ventricular myocardium (17 segments) were analyzed, and the PSD and GLPS were automatically calculated with AFI software. Normally distributed measurement data among multiple groups were compared by one-way ANOVA; comparisons between two groups were performed by LSD-t method. Non-normally distributed measurement data among multiple groups and between two groups were compared by the rank sum test. The clinical value of PSD in the diagnosis of left ventricular systolic non-synchronization was analyzed using the receiver operating characteristic (ROC) curve. Pearson correlation analysis was used for normal distribution variables, otherwise Spearman correlation analysis was used. Twenty patients were randomly selected for PSD intraobserver and interobserver reproducibility tests.

Results

The longitudinal strain peak time in each segment of the left ventricle in the three treatment groups was increased, and the PSD was significantly higher than that of the control group (P＜0.05/6). The absolute values of GLPS in the hemodialysis group and peritoneal dialysis group were significantly lower than that of the control group (P＜0.05/6). However, there was no significant difference in GLPS between the renal transplantation group and the control group (P＞0.05/6). PSD and GLPS in the kidney transplantation group were significantly different from those of the hemodialysis group and peritoneal dialysis group (P＜0.05/6). There was no significant difference in PSD or GLPS between the hemodialysis group and peritoneal dialysis group (P＞0.05/6). PSD values of the hemodialysis group [(50.29±17.12) ms] and the peritoneal dialysis group [(56.21±19.85) ms] were significantly higher than those of the control group [(30.48±7.12) ms; t=-6.101, -6.467; P＜0.05/6] and the kidney transplantation group [(39.80±5.65) ms; t=-3.234, -4.179; P＜0.05/6]. The absolute values of GLPS in the hemodialysis group [(16.12±3.35)%] and the peritoneal dialysis group [(16.61±3.84)%] were lower than those of the control group [(21.34±2.88)%; t=-6.699, -5.494; P＜0.05/6] and the kidney transplantation group [(19.80±2.94)%; t=-4.619, -3.631; P＜0.05/6]. In the three ESRD treatment groups, PSD had a positive correlation with left ventricular mass index (r=0.632, P＜0.05) and negative correlation with GLPS absolute value (r=-0.468, P＜0.05). The best cut-off point of PSD was 34.5 ms, and the AUC was 0.872. The sensitivity for predicting left ventricular systolic asynchrony was 85.4%, and the specificity was 78.8%. PSD measurements have good repeatability and stability between and within the observers (correlation coefficients =0.978, 0.991).

Conclusion

Renal transplantation is the best replacement treatment for ESRD. PSD is a comprehensive, intuitive, and accurate new index for evaluating left ventricular myocardial synchronization, and it is easy to measure, reproduce, and popularize and can predict left ventricular systolic asynchrony in patients with chronic kidney disease. It has certain guiding significance for clinical early intervention and treatment of cardiovascular complications. PSD and GLPS can be used to evaluate left ventricular myocardial contractile function in patients with ESRD with reserved LVEF, and to conduct clinical diagnosis and efficacy evaluation.

Key words: Peak strain dispersion, Global longitudinal peak strain, Synchrony hemodialysis, Peritoneal dialysis, Kidney transplantation, Echocardiography, Two-dimensional speckle tracking imaging, End-stage renal disease

Kana Li, Zhelan Zheng, Jiangtao Wang. Peak strain dispersion and global longitudinal peak strain for evaluating left ventricular function and systolic synchrony in patients with end-stage renal disease receiving different replacement therapies[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2021, 18(03): 258-265.

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URL: https://chaosheng.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1672-6448.2021.03.004

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Figures/Tables 6

组别	例数	女/男（例）	年龄（岁， $x ¯$ ±s）	体质量指数[kg/m²，M（Q_R）]	体表面积[m²，M（Q_R）]	收缩压（mmHg， $x ¯$ ±s）	舒张压（mmHg， $x ¯$ ±s）	脉压[mmHg，M（Q_R）]
对照组	33	21/12	39.00±13.10	21.97（20.06，24.31）	1.59（1.46，1.70）	115.55±9.02	76.00±8.84	40.0（37.0，40.0）
肾移植组	30	12/18	40.50±9.85	21.47（19.72，24.13）	1.64（1.52，1.76）	122.87±10.97	78.43±8.63	44.5（40.0，50.0）^a
血液透析组	31	15/16	44.84±18.35	19.22（17.42，21.88）^b	1.53（1.40，1.61）	133.39±15.86^bd	82.23±12.03	50.0（40.0，60.0）^b
腹膜透析组	28	10/18	43.71±12.32	20.88（18.80，25.24）	1.60（1.46，1.75）	133.39±14.47^ce	85.89±9.84^ce	41.0（40.0，58.3）
统计值		χ²=5.691	F=2.149	H=9.881	H=5.684	F=14.523	F=17.905	H=16.367
P值		0.128	0.542	0.020	0.118	＜0.001	0.001	0.001

组别	例数	女/男（例）	年龄（岁， $x ¯$ ±s）	体质量指数[kg/m²，M（Q_R）]	体表面积[m²，M（Q_R）]	收缩压（mmHg， $x ¯$ ±s）	舒张压（mmHg， $x ¯$ ±s）	脉压[mmHg，M（Q_R）]
对照组	33	21/12	39.00±13.10	21.97（20.06，24.31）	1.59（1.46，1.70）	115.55±9.02	76.00±8.84	40.0（37.0，40.0）
肾移植组	30	12/18	40.50±9.85	21.47（19.72，24.13）	1.64（1.52，1.76）	122.87±10.97	78.43±8.63	44.5（40.0，50.0）^a
血液透析组	31	15/16	44.84±18.35	19.22（17.42，21.88）^b	1.53（1.40，1.61）	133.39±15.86^bd	82.23±12.03	50.0（40.0，60.0）^b
腹膜透析组	28	10/18	43.71±12.32	20.88（18.80，25.24）	1.60（1.46，1.75）	133.39±14.47^ce	85.89±9.84^ce	41.0（40.0，58.3）
统计值		χ²=5.691	F=2.149	H=9.881	H=5.684	F=14.523	F=17.905	H=16.367
P值		0.128	0.542	0.020	0.118	＜0.001	0.001	0.001

组别	例数	IVSd[mm，M（Q_R）]	LVPWd[mm，M（Q_R）]	RWT[M（Q_R）]	LVM[g，M（Q_R）]	LVMI[M（Q_R）]	AOD（mm， $x ¯$ ±s）	LAD（mm， $x ¯$ ±s）
对照组	33	8.00（7.00，8.00）	8.00（7.00，8.00）	0.34（0.33，0.36）	121.66（97.03，144.60）	78.10（63.80，85.42）	28.30±2.59	33.03±2.47
肾移植组	30	9.00（8.00，9.00）^a	9.00（8.00，9.00）^a	0.37（0.33，0.40）	161.78（127.09，189.65）^a	95.90（81.87，107.38）^a	28.80±2.52	36.50±4.64
血液透析组	31	10.00（9.00，11.00）^bd	10.00（8.00，11.00）^bd	0.40（0.37，0.45）^bd	172.63（146.70，231.17）^b	114.09（94.44，153.65）^bd	30.03±3.05	38.74±6.62^b
腹膜透析组	28	10.00（8.00，12.75）^ce	9.00（8.00，12.75）^c	0.39（0.35，0.47）^c	200.39（142.63，269.86）^c	118.52（90.52，153.14）^ce	29.25±2.65	39.04±6.96^c
统计值		H=42.786	H=40.461	H=22.312	H=34.388	H=42.359	F=2.320	F=8.316
P值		＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	0.079	＜0.001
组别	例数	LVEDV[ml，M（Q_R）]	LVESV[ml，M（Q_R）]	LVDd（mm， $x ¯$ ±s）	LVDs[mm，M（Q_R）]	LVEF[%，M（Q_R）]	LVFS[%，M（Q_R）]
对照组	33	91.28（78.10，103.84）	26.29（21.67，34.32）	44.64±3.41	26.00（24.50，39.50）	71.00（65.50，74.00）	40.00（35.50，43.00）
肾移植组	30	102.83（84.32，120.86）	31.26（24.54，38.16）	47.10±4.61	29.00（26.00，31.25）	71.50（63.75，74.00）	40.50（34.75，42.25）
血液透析组	31	95.65（89.22，134.97）	31.99（25.76，49.00）^b	47.42±6.49	29.00（27.00，34.00）^b	64.00（56.00，71.00）^bd	35.00（29.00，40.00）^b
腹膜透析组	28	102.00（83.25，138.49）	33.48（24.61，47.65）^c	48.64±8.18	29.50（26.25，33.75）^c	65.50（61.25，69.75）	36.00（32.25，39.75）
统计值		H=6.061	H=8.350	F=2.557	H=11.341	H=12.653	H=11.730
P值		0.109	0.039	0.058	0.010	0.005	0.008

组别	例数	IVSd[mm，M（Q_R）]	LVPWd[mm，M（Q_R）]	RWT[M（Q_R）]	LVM[g，M（Q_R）]	LVMI[M（Q_R）]	AOD（mm， $x ¯$ ±s）	LAD（mm， $x ¯$ ±s）
对照组	33	8.00（7.00，8.00）	8.00（7.00，8.00）	0.34（0.33，0.36）	121.66（97.03，144.60）	78.10（63.80，85.42）	28.30±2.59	33.03±2.47
肾移植组	30	9.00（8.00，9.00）^a	9.00（8.00，9.00）^a	0.37（0.33，0.40）	161.78（127.09，189.65）^a	95.90（81.87，107.38）^a	28.80±2.52	36.50±4.64
血液透析组	31	10.00（9.00，11.00）^bd	10.00（8.00，11.00）^bd	0.40（0.37，0.45）^bd	172.63（146.70，231.17）^b	114.09（94.44，153.65）^bd	30.03±3.05	38.74±6.62^b
腹膜透析组	28	10.00（8.00，12.75）^ce	9.00（8.00，12.75）^c	0.39（0.35，0.47）^c	200.39（142.63，269.86）^c	118.52（90.52，153.14）^ce	29.25±2.65	39.04±6.96^c
统计值		H=42.786	H=40.461	H=22.312	H=34.388	H=42.359	F=2.320	F=8.316
P值		＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	0.079	＜0.001
组别	例数	LVEDV[ml，M（Q_R）]	LVESV[ml，M（Q_R）]	LVDd（mm， $x ¯$ ±s）	LVDs[mm，M（Q_R）]	LVEF[%，M（Q_R）]	LVFS[%，M（Q_R）]
对照组	33	91.28（78.10，103.84）	26.29（21.67，34.32）	44.64±3.41	26.00（24.50，39.50）	71.00（65.50，74.00）	40.00（35.50，43.00）
肾移植组	30	102.83（84.32，120.86）	31.26（24.54，38.16）	47.10±4.61	29.00（26.00，31.25）	71.50（63.75，74.00）	40.50（34.75，42.25）
血液透析组	31	95.65（89.22，134.97）	31.99（25.76，49.00）^b	47.42±6.49	29.00（27.00，34.00）^b	64.00（56.00，71.00）^bd	35.00（29.00，40.00）^b
腹膜透析组	28	102.00（83.25，138.49）	33.48（24.61，47.65）^c	48.64±8.18	29.50（26.25，33.75）^c	65.50（61.25，69.75）	36.00（32.25，39.75）
统计值		H=6.061	H=8.350	F=2.557	H=11.341	H=12.653	H=11.730
P值		0.109	0.039	0.058	0.010	0.005	0.008

组别	例数	GLPS绝对值（%）	PSD（ms）
对照组	33	21.34±2.88	30.48±7.12
肾移植组	30	19.80±2.94	39.80±5.65^a
血液透析组	31	16.12±3.35^bd	50.29±17.12^bd
腹膜透析组	28	16.61±3.84^ce	56.21±19.85^ce
F值		18.649	21.357
P值		＜0.001	＜0.001

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