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.

中文翻译：

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维持性血液透析患者左心室收缩功能和同步性的特定层斑点跟踪分析。

背景技术这项研究调查了二维斑点跟踪超声心动图（2D-STE）进行的特定层应变分析在评估维持性血液透析（MHD）患者左心室（LV）收缩功能和同步性中的价值。方法本研究共纳入34名MHD患者和35名健康对照。在左心室长轴，四腔室和两腔室以及左心室短，短轴视图收集基底，中层和心尖段的动态图像。使用特定层的斑点跟踪（LST）技术分析左心内膜，心中膜，心外膜下膜的纵向应变（LS）和周向应变（CS），总纵向应变（GLS），总周向应变（GCS），达到峰值LS的LV 17段时间（TTP）和峰值应变离散（PSD）。比较对照组和MHD组之间这些参数的差异，并检查PSD与每个LS参数之间的相关性。接受者操作者特征曲线（ROC）用于评估MHD患者的三个心肌层LS和CS在评估LV收缩功能障碍中的功效。结果MHD患者的左心室射血分数（LVEF）相当，但与对照组相比，LV GLS，GCS以及三层LS和CS明显更小。与正常受试者相比，MHD患者的基础节段，中段和心尖段的三个心肌层LS明显减少，而基础节段，中段和心尖段的三个心肌层CS明显减少。 MHD患者与正常受试者相比，除了中间和心尖段的心内膜外。与对照组相比，MHD患者的LV 17节段和PSD的TTP明显更高，并且在大多数节段中延迟了峰值时间。此外，MHD患者的PSD与心内膜下和心肌中层LS和GLS正相关，而与心外膜下LS不相关。MHD患者心内膜下，心中膜下和心外膜下LS的曲线下面积（AUC）分别为0.894、0.852和0.870；心外膜下，心肌中层和心内膜下CS的AUC分别为0.852、0.837和0.669。结论LST可以检测MHD患者所有三层LS和CS和PSD的早期变化，因此是诊断MHD患者左室收缩功能障碍的有价值的工具。与对照组相比，MHD患者的LV 17节段和PSD的TTP明显更高，并且在大多数节段中延迟了峰值时间。此外，MHD患者的PSD与心内膜下和心肌中层LS和GLS正相关，而与心外膜下LS不相关。MHD患者心内膜下，心中膜下和心外膜下LS的曲线下面积（AUC）分别为0.894、0.852和0.870；心外膜下，心肌中层和心内膜下CS的AUC分别为0.852、0.837和0.669。结论LST可以检测MHD患者所有三层LS和CS和PSD的早期变化，因此是诊断MHD患者左室收缩功能障碍的有价值的工具。与对照组相比，MHD患者的LV 17节段和PSD的TTP明显更高，并且在大多数节段中延迟了峰值时间。此外，MHD患者的PSD与心内膜下和心肌中层LS和GLS正相关，而与心外膜下LS不相关。MHD患者心内膜下，心中膜下和心外膜下LS的曲线下面积（AUC）分别为0.894、0.852和0.870；心外膜下，心肌中层和心内膜下CS的AUC分别为0.852、0.837和0.669。结论LST可以检测MHD患者所有三层LS和CS和PSD的早期变化，因此是诊断MHD患者左室收缩功能障碍的有价值的工具。MHD患者的PSD与心内膜下和心肌中层LS和GLS正相关，而与心外膜下LS不相关。MHD患者心内膜下，心中膜下和心外膜下LS的曲线下面积（AUC）分别为0.894、0.852和0.870；心外膜下，心肌中层和心内膜下CS的AUC分别为0.852、0.837和0.669。结论LST可以检测MHD患者所有三层LS和CS和PSD的早期变化，因此是诊断MHD患者左室收缩功能障碍的有价值的工具。MHD患者的PSD与心内膜下和心肌中层LS和GLS正相关，而与心外膜下LS不相关。MHD患者心内膜下，心中膜下和心外膜下LS的曲线下面积（AUC）分别为0.894、0.852和0.870；心外膜下，心肌中层和心内膜下CS的AUC分别为0.852、0.837和0.669。结论LST可以检测MHD患者所有三层LS，CS和PSD的早期变化，因此是诊断MHD患者左室收缩功能障碍的有价值的工具。心肌中和心内膜下CS分别为0.852、0.837和0.669。结论LST可以检测MHD患者所有三层LS和CS和PSD的早期变化，因此是诊断MHD患者左室收缩功能障碍的有价值的工具。心肌中和心内膜下CS分别为0.852、0.837和0.669。结论LST可以检测MHD患者所有三层LS和CS和PSD的早期变化，因此是诊断MHD患者左室收缩功能障碍的有价值的工具。