August 20, 2018BioMedical Engineering OnLineOpen Access

Ultrasonic image analysis of longitudinal strain in uremic patients with preserved left ventricular ejection fraction

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Why the study?

Does two-dimensional speckle-tracking echocardiography identify subclinical left ventricular myocardial dysfunction in uremic patients with preserved LVEF compared to healthy controls?

Structured PICO

Does two-dimensional speckle-tracking echocardiography identify subclinical left ventricular myocardial dysfunction in uremic patients with preserved LVEF compared to healthy controls?

Population

64 participants (31 clinically stable uremic outpatients on regular hemodialysis with LVEF ≥ 55% and 33 age- and sex-matched healthy volunteers). Exclusions: arrhythmia, primary hypertension, previous myocardial infarction, moderate or large hydropericardium, or LV systolic dysfunction with LVEF < 55%.

Intervention

Two-dimensional speckle-tracking echocardiography (2DSTE) to assess peak longitudinal strain (LS) and time to peak LS

Comparator

Age- and sex-matched healthy volunteers with normal physical examination, ECG, chest radiography, renal function, and echocardiography results

Outcome

Peak longitudinal strain in the basal, mid, and apical LV (BLS, MLS, and ALS) and the respective time to peak LS (T-BLS, T-MLS, T-ALS)surrogate

Two-dimensional speckle-tracking echocardiography can identify early subclinical left ventricular myocardial abnormalities, specifically impaired longitudinal strain and delayed time to peak strain, in uremic patients with preserved LVEF.

Limitations

small sample size
single center
patients were not followed over the long term to document the occurrence of cardiovascular events

Implication

2DSTE may identify subclinical LV dysfunction in uremic patients with preserved LVEF; leaves open whether strain parameters should guide therapy.

Abstract

BACKGROUND: Patients with uremia have high cardiovascular disease morbidity and mortality despite having normal left ventricular ejection fraction (LVEF). Longitudinal strain (LS) can be associated with subtle changes in LV systolic function. The aim of this study was to use two-dimensional speckle-tracking echocardiography (2DSTE) to assess subclinical LV myocardial dysfunction and to explore strain-changing regularities in uremic patients with LVEF ≥ 55%. METHODS: The study population included 40 uremic patients and 40 healthy volunteers. 2DSTE was performed on all participants to assess peak LS in the basal, mid and apical LV (BLS, MLS and ALS) and the respective time to peak LS (T-BLS, T-MLS, T-ALS). RESULTS: BLS, MLS, and ALS were significantly decreased in the uremic group relative to healthy controls and LS increased going in a basal to apical direction in both groups. T-BLS, T-MLS and T-ALS was significantly increased in the uremic group compared with the control group. In uremic patients, T-BLS, but not T-MLS or T-ALS, was significantly delayed relative to the control group. Bivariate analysis of creatinine (Cr) or urea nitrogen and strain parameters revealed a correlation only between ALS and Cr. CONCLUSION: 2DSTE can identify LV myocardial abnormalities in uremic patients with preserved LVEF at early stage, as well as some changing regularities of LS and T-LS in the left ventricle.