Layer-specific speckle tracking analysis of left ventricular systolic function and synchrony in maintenance hemodialysis patients

Abstract

Background: This study investigated the value of layer-specific strain analysis by two-dimensional speckle tracking echocardiography (2D-STE) for evaluating left ventricular (LV) systolic function and synchrony in maintenance hemodialysis (MHD) patients. Methods: A total of 34 MHD patients and 35 healthy controls were enrolled in this study. Dynamic images were collected at the LV apical long-axis, the four-and two-chamber, and the LV short-axis views at the basal, middle, and apical segments. The layer-specific speckle tracking (LST) technique was used to analyze the longitudinal strain (LS) and circumferential strain (CS) of LV sub-endocardium, mid-myocardium, sub-epicardium, global longitudinal strain (GLS), global circumferential strain (GCS), the LV 17 segment time to peak LS (TTP), and the peak strain dispersion (PSD). The differences in these parameters were compared between control and MHD groups, and the correlation between PSD and each LS parameter was examined. The receiver operator characteristic (ROC) curve was used to evaluate the efficacy of three myocardial layer LS and CS in the assessment of LV systolic dysfunction in MHD patients. Results: MHD patients had comparable left ventricular ejection fraction (LVEF), but significantly smaller LV GLS, GCS, and three-layer LS and CS compared to the control group. The three myocardial layer LS of the basal segment, middle segment, and apex segment was significantly reduced in the MHD patients compared to the normal subjects, while the three myocardial layer CS of the basal segment, middle segment, and apex segment was significantly reduced in the MHD patients compared to the normal subjects, except for the sub-endocardium of the middle and apex segment. MHD patients had significantly higher TTP of LV 17 segments and PSD compared to controls, and had delayed peak time in most segments. In addition, PSD of MHD patients was positively correlated with sub-endocardial and mid-myocardial LS and GLS, but not with sub-epicardial LS. The area under the curves (AUCs) of sub-endocardial, mid-myocardial, and sub-epicardial LS in MHD patients were 0.894, 0.852, and 0.870, respectively; the AUCs of sub-epicardial, mid-myocardial, and sub-endocardial CS were 0.852, 0.837, and 0.669, respectively. Conclusions: LST may detect early changes of all three-layer LS and CS and PSD in MHD patients, and is therefore a valuable tool to diagnose LV systolic dysfunction in MHD patients.

Value of quantitative analysis of left ventricular systolic function in patients on maintenance hemodialysis based on myocardial work technique

“…Moreover, with the increase in the LV thickness and prolongation of the dialysis time, the GLS decreased significantly, which was accompanied by a decrease in the LV systolic function, as evidenced by the lower GLS in MHD with LVH patients than in NLVH patients. These findings were in line with our previous report [ 21 ]. GLS is usually obtained from 2D-STI technology, which quantitatively measures the mechanical parameters for LV function [ 22 , 23 ].…”

Assessment of left heart dysfunction to predict doxorubicin cardiotoxicity in children with lymphoma

“…Except for GLS, the layered strain technique compensates for the various effects of global strain on the structure and direction of each layer of myocardium. It demonstrates the longitudinal strain damage of each layer of myocardium by reflecting the relationship between muscle fiber structure and damage of the three layers of the ventricular myocardium (8). Thus, the prominent advantage of the myocardial work technique is that considering the myocardial deformation and afterload can better reflect the myocardial energy metabolism (9)(10)(11).…”