Noninvasive Evaluation of Myocardial Work in Hemodialysis Patients By Left Ventricular Pressure-Strain Loop Technique

Background Noninvasive left ventricular pressure-strain loop was used to evaluate the changes of myocardial work index in maintenance hemodialysis (MHD) patients.Methods We included 62 patients undergoing regular hemodialysis (HD) at the First Affiliated Hospital of Soochow University from July 2020 to October 2022. Left ventricular ejection fraction (LVEF) was measured by Simpson biplane method. Pulsed Doppler was used to calculate cardiac output (CO). Left ventricular longitudinal strain was obtained by two-dimensional speckle tracking imaging (2D-STI). Systolic blood pressure and diastolic blood pressure were input to obtain global work index (GWI), global constructive work (GCW), global wasted work (GEE) and global work efficiency (GWE). The differences of echocardiographic parameters before and after HD treatment were compared.Results After HD treatment, the size of cardiac chambers, LVEF and cardiac output decreased compared with those pre-HD (P < 0.05); Heart rate was faster than pre-HD (P < 0.05). Left ventricular diastolic function parameters (E-wave, A-wave, Septal e', Lateral e', E/e’ and PASP) were lower than pre-HD; GLS, GWI and GCW decreased after HD treatment (P < 0.05); There were no significant changes in GWW and GWE between HD sessions (P > 0.05).Conclusion Hemodialysis removed excessive fluids, the heart chambers became smaller. LVEF and CO declined, but remained within normal ranges. Left ventricular diastolic function was improved compared with pre-HD. PSL technique can effectively evaluate left ventricular myocardial work, and can provide a new approach for evaluating volume load and left ventricular myocardial function in HD patients. It is further verified that the myocardial work parameters have good repeatability.