Left ventricular myocardial function in hemodialysis and nondialysis uremia patients: a three-dimensional speckle-tracking echocardiography study

Ran Chen; Xia Wu; Li-Jun Shen; Bei Wang; Ming-Ming Ma; Yuan Yang; Bo-Wen Zhao

doi:10.1371/journal.pone.0100265

Left ventricular myocardial function in hemodialysis and nondialysis uremia patients: a three-dimensional speckle-tracking echocardiography study

PLoS One. 2014 Jun 24;9(6):e100265. doi: 10.1371/journal.pone.0100265. eCollection 2014.

Authors

Ran Chen¹, Xia Wu², Li-Jun Shen³, Bei Wang¹, Ming-Ming Ma¹, Yuan Yang¹, Bo-Wen Zhao¹

Affiliations

¹ Department of Diagnostic Ultrasound and Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine and Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University, Hangzhou, China.
² Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine and Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University, Hangzhou, China.
³ Department of Ultrasound, The First People's Hospital, Hangzhou Xiao Shan District, Hangzhou, China.

Abstract

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.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Case-Control Studies
Echocardiography, Three-Dimensional
Female
Humans
Male
Middle Aged
Renal Dialysis
Reproducibility of Results
Stroke Volume
Uremia / complications*
Uremia / diagnosis
Uremia / therapy
Ventricular Dysfunction, Left / diagnostic imaging*
Ventricular Dysfunction, Left / etiology*

Grants and funding

The research is supported by Specialized Research Fund for the Doctoral Program of Higher Education (20110101120136). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.