Early Detection of Heart Failure with Preserved Ejection Fraction in Uremic Patients Using Three-Dimensional Speckle-Tracking Imaging

INTRODUCTION: Conventional echocardiography does not identify abnormal cardiac function for heart failure with preserved ejection fraction (HFpEF) in patients with uremia. This study aimed to investigate the diagnostic value of three-dimensional speckle-tracking imaging (3D-STI) for HFpEF in uremia patients. METHODS: A total of 108 participants were divided into the non-HFpEF group (n = 54) and the HFpEF group (n = 54) based on whether they met the diagnostic criteria for HFpEF as specified in the 2021 European Society of Cardiology Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure. The study compared various parameters between two groups, including global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), global area strain (GAS), left ventricular global peak twist angle (twist), and torsion. Multivariate logistic regression analysis was used to analyze the factors influencing HFpEF. Receiver operating characteristic (ROC) curve analysis was employed to evaluate the area under the curve (AUC) of GLS, GCS, GRS, GAS, twist, and torsion parameters in predicting the occurrence of HFpEF in uremia patients. Cox regression analysis was used to analyze the prognostic value of GLS for recurrent adverse cardiovascular events. RESULTS: Compared to the non-HFpEF group, the HFpEF group showed lower values for GLS, GCS, GRS, GAS, twist, and torsion (p < 0.05). Multivariate logistic regression showed that GLS was an independent risk factor for HFpEF in patients with uremia (Exp(B) = 1.586, p < 0.001). ROC curve analysis showed that GLS had an AUC value of 0.794, with a sensitivity of 90.7% and a specificity of 55.6%. The GAS, with an AUC value of 0.793, had a sensitivity of 88.9% and a specificity of 53.8%. The GRS, with an AUC value of 0.803, had a sensitivity of 88.9% and a specificity of 57.4%. Cox regression analysis showed that GLS was a risk factor for recurrent adverse cardiovascular events (p < 0.05). CONCLUSIONS: 3D-STI is effective in identifying altered cardiac function indicative of HFpEF in uremic patients, demonstrating potential predictive value.