Key result
Nondialysis uremic patients with preserved ejection fraction had significantly decreased global three-dimensional strain compared to hemodialysis patients and healthy controls (P<0.001).
Why the study?
Are there differences in left ventricular myocardial strain assessed by three-dimensional speckle-tracking echocardiography between hemodialysis patients, nondialysis uremic patients, and healthy controls with preserved LVEF?
Cross-Sectional (n=97)
Single-blind
No
Are there differences in left ventricular myocardial strain assessed by three-dimensional speckle-tracking echocardiography between hemodialysis patients, nondialysis uremic patients, and healthy controls with preserved LVEF?
Absolute Event Rate: -17.75% vs -25.52%
p-value: p=<0.001
Three-dimensional speckle-tracking echocardiography can detect subclinical myocardial dysfunction in uremic patients with preserved LVEF, demonstrating that strain parameters are better preserved in hemodialysis patients compared to nondialysis patients.
3D strain may flag subclinical impairment in nondialysis uremia; leaves open prospective validation for risk stratification or management.
BACKGROUND: Several studies have demonstrated that uremic patients who have preserved left ventricular ejection fraction (LVEF) could still have the potential for systolic dysfunction. The aim of this study was to assess the differences between the left ventricular (LV) myocardial function in hemodialysis and nondialysis uremic patients based on three-dimensional speckle-tracking echocardiography. METHODS: The study population consisted of 35 maintenance hemodialysis patients (the hemodialysis group), 30 uremic patients who were hospitalized for the creation of a primary arteriovenous fistula (the nondialysis group), and 32 healthy volunteers. All of the patients had normal left ventricular ejection fractions (i.e., 55% or greater). Three-dimensional speckle tracking echocardiography was performed to assess the left ventricle's global three-dimensional strain, regional longitudinal strain, circumferential strain, and radial strain. RESULTS: The left ventricular regional longitudinal strain, radial strain, circumferential strain, and global three-dimensional strain were significantly decreased in the nondialysis patients compared with the other two groups (all, P<0.001). However, the three-dimensional strain and the regional longitudinal strain were lower in the hemodialysis patients than in the controls (P<0.01). In the hemodialysis patients and the control group, the longitudinal strain, circumferential strain, and radial strain were higher at the apical level than they were at the basal level and midlevels. A multivariate linear regression analysis showed that the blood urea nitrogen and creatinine levels were independently associated with the values of the global three-dimensional strain (β = -0.217, P = 0.000; β = -0.243, P = 0.011, respectively) and the longitudinal strain (β = -0.154, P = 0.032; β = -0.188, P = 0.029, respectively). CONCLUSIONS: Three-dimensional speckle-tracking echocardiography may detect myocardial dysfunction in patients with uremia who have preserved LVEF. The global three-dimensional strain and the regional longitudinal strain appear to be superior in hemodialysis patients compared with nondialysis patients.
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Chen et al. (2014) conducted a cross-sectional in Uremia with preserved left ventricular ejection fraction (n=97). Nondialysis uremia vs. Hemodialysis and healthy controls was evaluated on Global three-dimensional strain (3DS) (p=<0.001). Nondialysis uremic patients with preserved ejection fraction had significantly decreased global three-dimensional strain compared to hemodialysis patients and healthy controls (P<0.001).
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