scholarly journals Left Ventricular Strain and Dyssynchrony in Young and Middle-Aged Peritoneal Dialysis Patients and Healthy Controls: A Case-Matched Study

2018 ◽  
Vol 8 (4) ◽  
pp. 271-284 ◽  
Author(s):  
Fei Shi ◽  
Sheng Feng ◽  
Jing Zhu ◽  
Yanni Wu ◽  
Jianchang Chen
Keyword(s):  
Peritoneal Dialysis ◽  
Myocardial Function ◽  
Left Ventricular ◽  
Inferior Wall ◽  
Pulsed Doppler ◽  
Middle Aged ◽  
Diastolic Velocity ◽  
Specific Analysis ◽  
Anterior Septum ◽  
Myocardial Layer

Background: This study aimed to evaluate the role of two-dimensional speckle-tracking imaging (2D-STI) and myocardial layer-specific analysis in evaluating early left ventricular (LV) myocardial function and systolic dyssynchrony in young and middle-aged uremic patients undergoing peritoneal dialysis (PD). Methods: We enrolled 31 PD patients aged ≤65 years with preserved LV ejection fraction (LVEF, ≥54%) as the PD group and 49 age-matched healthy people as the control group. Echocardiography was used to assess the left atrial diameter index (LADI, LAD/BSA), LV mass index (LVMI), LVEF, peak early diastolic velocity/late diastolic velocity (E/A) (measured by pulsed Doppler), and peak early diastolic velocity (by pulsed Doppler)/peak velocity of the early diastolic wave (by pulsed-wave tissue Doppler) (E/e′). Next, we used 2D-STI and myocardial layer-specific analysis to obtain longitudinal strains (LS) of the endocardium (LSendo), the myocardium (LSmyo), the epicardium (LSepi), and the global myocardium (GLS). Then, we measured the postsystolic index (PSI) to evaluate LV myocardial function. Time to peak LS (TTP) and peak strain dispersion (PSD) from 17 consecutive segments were assessed to quantify LV dyssynchrony. Results: Compared with the controls, PD patients had significantly increased LADI (p = 0.041), LVMI (p = 0.000), and E/e′ (p = 0.009), but reduced LVEF (p = 0.000) and E/A (p = 0.000). The average values of GLS (GLS avg) (p = 0.01) and GLS of the apical 2-chamber view (p = 0.003), including the LSendo (p = 0.024), LSmyo (p = 0.024), and LSepi (p = 0.032), were significantly decreased in patients with PD compared with controls. In PSI, segments of LS were markedly delayed in the anterior septum (p = 0.047), anterior (p = 0.000) and septum wall (p = 0.024) from basal segments, anterior wall (p = 0.001) from middle segments, and anterior (p = 0.024) and inferior (p = 0.024) wall from apical segments. Moreover, PSD was significantly increased in PD patients (p = 0.015), while TTP was evidently delayed in the anterior septum (p = 0.004), anterior (p = 0.000) and posterior (p = 0.042) wall from basal segments, and inferior wall (p = 0.048) from apical segments. Conclusions: Despite preserved LVEF, young and middle-aged PD patients developed LV dysfunction and myocardial systolic dyssynchrony earlier compared with controls.

scholarly journals Global diastolic strain rate for the assessment of left ventricular diastolic dysfunction in young peritoneal dialysis patients: a case control study

2020 ◽  
Author(s):  
Jing Zhu ◽  
Fei Shi ◽  
Tao You ◽  
Chao Tang ◽  
Jianchang Chen
Keyword(s):  
Peritoneal Dialysis ◽  
Strain Rate ◽  
Diastolic Dysfunction ◽  
Diastolic Function ◽  
Peak Velocity ◽  
Left Ventricular ◽  
Volume Index ◽  
Diastolic Strain Rate ◽  
Diastolic Velocity ◽  
Lv Diastolic Function

Abstract Background: Left ventricular (LV) myocardial longitudinal diastolic strain rate measured by two-dimensional speckle tracking imaging (2D-STI) was proved to have a better correlation with the LV diastolic function. We aimed to use this sensitive tool to predict LV myocardial diastolic dysfunction in young peritoneal dialysis (PD) patients with preserved LV ejection fraction (LVEF).Methods: We enrolled 30 PD patients aged ≤60 with LVEF ≥54% and classified as normal LV diastolic function by conventional echocardiography, and 30 age- and sex-matched healthy people as the control group. The left atrial maximum volume index (LAVI), LV mass index (LVMI), LVEF, LV posterior wall thickness (LVPWT), interventricular septal thickness (IVST), peak velocity of tricuspid regurgitation (TR), peak early diastolic velocity/late diastolic velocity(by Pulsed Doppler) (E/A) and E/peak velocity of the early diastolic wave (by Pulsed-wave tissue Doppler) (E/e’) were recorded by conventional echocardiographic. Next, the average LV global longitudinal systolic strain (GLS avg) and the average LV global longitudinal diastolic strain rate (DSr avg) during early diastole (DSrE avg), late diastole (DSrA avg) and isovolumic relaxation period (DSrIVR avg) were obtained from 2D-STI. Combined them with E, the new noninvasive indexes (E/DSrE avg, E/DSrA avg and E/DSrIVR avg) were derived.Results: The PD group ’s LVEF, E/e¢, TR and LAVI were in the normal range compared with the controls, and only e¢ (p<0.001) was decreased. The LVMI (p<0.001), LVPWT (p<0.001), IVST (p<0.001) increased while E/A (p<0.001) decreased. The GLS avg (p=0.008) was significantly decreased in PD patients compared with the controls. DSrA avg (p=0.006) and E/DSrE avg (p=0.006) were increased, while DSrE avg (p<0.001), DSrIVR avg (p=0.017) and E/DSrA avg (p<0.001) decreased. After the multivariable regression analysis, the correlation between DSrE and the conventional parameters including LVPWT (p<0.001), E/A (p<0.001) still remained significant. Conclusions: Young PD patients with preserved LVEF already exhibited myocardial diastolic dysfunction. Global diastolic strain rate indexes were valuable parameters to evaluate diastolic dysfunction. Additionally, LVPWT was highly correlated with DSrE, such parameter should be taken into account for predicting the early LV diastolic dysfunction in clinical practice.

scholarly journals Global diastolic strain rate for the assessment of left ventricular diastolic dysfunction in young peritoneal dialysis patients: a case control study

2020 ◽  
Author(s):  
Jing Zhu ◽  
Fei Shi ◽  
Tao You ◽  
Chao Tang ◽  
Jianchang Chen
Keyword(s):  
Peritoneal Dialysis ◽  
Strain Rate ◽  
Diastolic Dysfunction ◽  
Diastolic Function ◽  
Peak Velocity ◽  
Left Ventricular ◽  
Volume Index ◽  
Diastolic Strain Rate ◽  
Diastolic Velocity ◽  
Lv Diastolic Function

Abstract Background: Left ventricular (LV) myocardial longitudinal diastolic strain rate measured by two-dimensional speckle tracking imaging (2D-STI) was proved to have a better correlation with the LV diastolic function. We aimed to use this sensitive tool to predict LV myocardial diastolic dysfunction in young peritoneal dialysis (PD) patients with preserved LV ejection fraction (LVEF). Methods: We enrolled 30 PD patients aged ≤60 with LVEF ≥54% and classified as normal LV diastolic function by conventional echocardiography, and 30 age- and sex-matched healthy people as the control group. The left atrial maximum volume index (LAVI), LV mass index (LVMI), LVEF, LV posterior wall thickness (LVPWT), interventricular septal thickness (IVST), peak velocity of tricuspid regurgitation (TR), peak early diastolic velocity/late diastolic velocity(by Pulsed Doppler) (E/A) and E/peak velocity of the early diastolic wave (by Pulsed-wave tissue Doppler) (E/e’) were recorded by conventional echocardiographic. Next, the average LV global longitudinal systolic strain (GLS avg) and the average LV global longitudinal diastolic strain rate (DSr avg) during early diastole (DSrE avg), late diastole (DSrA avg) and isovolumic relaxation period (DSrIVR avg) were obtained from 2D-STI. Combined them with E, the new noninvasive indexes (E/DSrE avg, E/DSrA avg and E/DSrIVR avg) were derived. Results: The PD group ’s LVEF, E/e¢, TR and LAVI were in the normal range compared with the controls, and only e¢ (p<0.001) was decreased. The LVMI (p<0.001), LVPWT (p<0.001), IVST (p<0.001) increased while E/A (p<0.001) decreased. The GLS avg (p=0.008) was significantly decreased in PD patients compared with the controls. DSrA avg (p=0.006) and E/DSrE avg (p=0.006) were increased, while DSrE avg (p<0.001), DSrIVR avg (p=0.017) and E/DSrA avg (p<0.001) decreased. After the multivariable regression analysis, the correlation between DSrE and the conventional parameters including LVPWT (p<0.001), E/A (p<0.001) still remained significant. Conclusions: Young PD patients with preserved LVEF already exhibited myocardial diastolic dysfunction. Global diastolic strain rate indexes were valuable parameters to evaluate diastolic dysfunction. Additionally, LVPWT was highly correlated with DSrE, such parameter should be taken into account for predicting the early LV diastolic dysfunction in clinical practice.

scholarly journals Global diastolic strain rate for the assessment of left ventricular diastolic dysfunction in young peritoneal dialysis patients: a case control study

2019 ◽  
Author(s):  
Jing Zhu ◽  
Fei Shi ◽  
Tao You ◽  
Chao Tang ◽  
Jianchang Chen
Keyword(s):  
Peritoneal Dialysis ◽  
Strain Rate ◽  
Diastolic Dysfunction ◽  
Diastolic Function ◽  
Peak Velocity ◽  
Left Ventricular ◽  
Volume Index ◽  
Diastolic Strain Rate ◽  
Diastolic Velocity ◽  
Lv Diastolic Function

Abstract Abstract Background: Left ventricular (LV) myocardial longitudinal diastolic strain rate measured by two-dimensional speckle tracking imaging (2D-STI) was proved to have a better correlation with the LV diastolic function. We aimed to use this sensitive tool to predict LV myocardial diastolic dysfunction in young peritoneal dialysis (PD) patients with preserved LV ejection fraction (LVEF). Methods: We enrolled 30 PD patients aged ≤60 with LVEF ≥54% and classified as normal LV diastolic function by conventional echocardiography, and 30 age- and sex-matched healthy people as the control group. The left atrial maximum volume index (LAVI), LV mass index (LVMI), LVEF, LV posterior wall thickness (LVPWT), interventricular septal thickness (IVST), peak velocity of tricuspid regurgitation (TR), peak early diastolic velocity/late diastolic velocity(by Pulsed Doppler) (E/A) and E/peak velocity of the early diastolic wave (by Pulsed-wave tissue Doppler) (E/e’) were recorded by conventional echocardiographic. Next, the average LV global longitudinal systolic strain (GLS avg) and the average LV global longitudinal diastolic strain rate (DSr avg) during early diastole (DSrE avg), late diastole (DSrA avg) and isovolumic relaxation period (DSrIVR avg) were obtained from 2D-STI. Combined them with E, the new noninvasive indexes (E/DSrE avg, E/DSrA avg and E/DSrIVR avg) were derived. Results: The PD group ’s LVEF, E/e, TR and LAVI were in the normal range compared with the controls, and only e (p<0.001) was decreased. The LVMI (p<0.001), LVPWT (p<0.001), IVST (p<0.001) increased while E/A (p<0.001) decreased. The GLS avg (p=0.008) was significantly decreased in PD patients compared with the controls. DSrA avg (p=0.006) and E/DSrE avg (p=0.006) were increased, while DSrE avg (p<0.001), DSrIVR avg (p=0.017) and E/DSrA avg (p<0.001) decreased. After the multivariable regression analysis, the correlation between DSrE and the conventional parameters including LVPWT (p<0.001), E/A (p<0.001) still remained significant. Conclusions: Young PD patients with preserved LVEF already exhibited myocardial diastolic dysfunction. Global diastolic strain rates such as DSrE, E/DSrE, DSrA, E/DSrA, and DSrIVR were valuable parameters to evaluate diastolic dysfunction. Additionally, LVPWT and E/A significantly influenced DSrE, such parameters should be taken into account for predicting the LV diastolic dysfunction in clinical practice.

Validation of a single crystal for measurement of transmural and epicardial thickening

1986 ◽  
Vol 251 (5) ◽  
pp. H1045-H1055 ◽  
Author(s):  
W. X. Zhu ◽  
M. L. Myers ◽  
C. J. Hartley ◽  
R. Roberts ◽  
R. Bolli
Keyword(s):  
Single Crystal ◽  
Transit Time ◽  
Coronary Occlusion ◽  
Myocardial Function ◽  
Sample Volume ◽  
Left Ventricular ◽  
Wall Thickening ◽  
Base Line ◽  
Pulsed Doppler ◽  
Wide Range

Conventional measurement of wall thickening with two transit-time crystals requires considerable skill, is associated with myocardial trauma, and does not discern the function of different layers of the left ventricular (LV) wall. To overcome these limitations, we have developed a 10 MHz pulsed Doppler technique that measures thickening at any depth of the LV wall from a single crystal sutured to the epicardium. To verify its accuracy, we compared measurements of thickening fraction (TF) by pulsed Doppler and transit-time methods in 25 open-chest dogs. The epicardial Doppler crystal was placed over an intramyocardial crystal positioned either in the subendocardium or midwall. The epicardial crystal acted as both the Doppler transducer and the transit-time transmitter, so that TF was measured by each technique at the same site. A wide range of regional function (transmural TF:-28-42%, epicardial TF:-20-28%) was produced by coronary occlusion followed by reperfusion, and by isoproterenol and phenylephrine infusions. There was a good correlation between the two methods, both for transmural TF (r = 0.98, 107 paired measurements) and epicardial TF (r = 0.99, 70 paired measurements). Despite marked changes in function, the two techniques yielded similar measurements under all of the conditions tested (base line, ischemia, 5, 15, 30, 60, 120, and 180 min of reperfusion, isoproterenol and phenylephrine). One-millimeter errors in selecting the depth of the Doppler sample volume did not significantly affect the accuracy of TF measurements. Thus the single pulsed Doppler crystal provides a simple, atraumatic, and accurate means for measuring myocardial function, both transmurally and in selected layers of the LV wall.

3078Usefulness of a semi-quantitative and layer-specific assessment of the relative apical sparing pattern of longitudinal strain for the identification of cardiac amyloidosis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Saito ◽  
M Imai ◽  
D Wake ◽  
R Higaki ◽  
T Sumimoto ◽  
...  
Keyword(s):  
Cardiac Amyloidosis ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Hypertensive Heart Disease ◽  
Left Ventricular ◽  
Discriminative Ability ◽  
Specific Analysis ◽  
Definition Of ◽  
Myocardial Layer ◽  
Better Than

Abstract Background The relative apical sparing pattern (RASP) of left ventricular longitudinal strain (LS) is determined using a strain polar map, while global longitudinal strain is measured using speckle-tracking echocardiography, and it is frequently associated with cardiac amyloidosis (CA). However, the definition of visual RASP is ambiguous, and this leads to insufficient reproducibility, whereas quantitative RASP takes time and leads to difficulty in the clinical application. Generally, amyloid predominantly accumulates in the endo-myocardial layer. As such, layer-specific analysis of RASP may more accurately identify CA. Therefore, the aims of this study were to explore the reproducible and easy definition of RASP for identifying CA and investigate the effect of layer-specific analysis on the assessment. Methods A total of 40 patients with CA diagnosed by biopsy and technetium pyrophosphate scintigraphy were compared with 120 control patients matched for mean left ventricular wall thickness (40 aortic stenosis, 40 hypertrophic cardiomyopathy, and 40 hypertensive heart disease). We compared the discriminative abilities of three definitions of RASP (visual, quantitative, and semi-quantitative). According to a previous paper, visual RASP was defined as visual reduction of LS in the basal and middle LS segments (light red or blue) relative to the apical LS (red). Quantitative RASP was calculated using the following formula: average apical LS/(average basal LS + average mid-ventricle LS), then binarized by the optimal cut-off value for predicting CA. Semi-quantitative RASP was defined as reduction of LS (≥-10%) in five or more segments out of the basal six segments, relative to apical LS (≤-15%). Sample cases are shown in Figure (left). Visual and semi-quantitative RASP were independently assessed by two blinded sonographers. The RASP at the endo-myocardial and all layers was evaluated using customized software. The concordance was assessed using the kappa statistic, whereas the discriminative ability was assessed using receiver operating characteristic curve analysis. Results The concordance of visual RASP was modest but its semi-quantitative RASP was perfect (Table right). The discriminative ability of semi-quantitative RASP at each layer was significantly better than that of visual RASP and close to that of the binary quantitative RASP. Additionally, the discriminative abilities of visual (p=0.10) and semi-quantitative (p=0.11) RASP at the endo-myocardial layer appeared to be better than those at all layers. Conclusions The assessment method of semi-quantitative RASP is easy and highly reproducible. Furthermore, it accurately discriminates CA. In addition, assessment at the endo-myocardial layer potentially improves the discriminative ability.

scholarly journals Comparison of the Effects of Dialysis Methods (Haemodialysis vs Peritoneal Dialysis) on Diastolic Left Ventricular Function Dialysis Methods and Diastolic Function

2016 ◽  
Vol 10 (1) ◽  
pp. 171-178 ◽  
Author(s):  
Fedoua Ellouali ◽  
Fatimazahra Berkchi ◽  
Rabia Bayahia ◽  
Loubna Benamar ◽  
Mohammed Cherti
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Diastolic Function ◽  
Mitral Annulus ◽  
Cardiovascular Complications ◽  
Left Ventricular ◽  
Chronic Haemodialysis ◽  
Diastolic Velocity ◽  
Lv Diastolic Function

Introduction:In patients undergoing chronic dialysis, several factors appear to influence the occurrence of cardiac abnormalities. The aim of our study was to evaluate the effects of two different methods of renal replacement therapy (chronic haemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD)) on left ventricular (LV) diastolic function.Patients and Methods:We enrolled 63 patients: 21 patients on CAPD, and 42 age- and gender-matched patients on HD; 35 patients were men (55.6%). Median of age was 46.4 (35-57) years. The median duration of renal replacement therapy was 3(2-5) years.Results:The two groups (HDvsPD) were similar concerning body mass index, dialysis duration and cardiovascular risk factors. The comparison of echocardiographic parameters showed statistically significant differences between two groups, regarding the presence of calcification, cardiac effusion, severely abnormal left ventricular hypertrophy(LVH) and the ratio of mitral velocity to early diastolic velocity of the mitral annulus (E/e’) >13 (p= 0.001, p= 0.003, p= 0.02, p= 0.004, respectively). In multivariate analysis, an E/e’>13 was higher in PD group ( OR= 5.8, CI [1.3-25.5], p=0.002).Conclusion:The method of dialysis seems to influence LV diastolic function. We observed a higher prevalence of diastolic LV dysfunction in the PD group. Echocardiographic follow up is essential as this could improve the management of cardiovascular complications in dialysis patients.

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