Diagnostic and prognostic value of parameters of erector spinae in patients with uremic sarcopenia.

AIM: This study aimed to investigate whether computed tomography (CT)-measured erector spinae parameters (ESPs) have diagnostic, severity assessment, and prognostic predictive value in uremic sarcopenia (US). MATERIALS AND METHODS: A total of 202 uremic patients were enrolled and divided into two groups: a control group and a sarcopenia group. Sarcopenia was classified into two types: severe and nonsevere. The area, volume, and density of the erector spinae (ES) were measured using chest CT images, and the relevant ESP, including the erector spinae index (ESI), total erector spinae volume (TESV), erector spinae density (ESD), and erector spinae gauge (ESG) were calculated. The occurrence of adverse events was followed-up for 36 months. The diagnostic value and severity of US were determined using the receiver operating characteristic (ROC) curve. Survival curves diagnosed using CT were plotted and compared with the curve drawn using the gold standard. Cox regression analysis was used to identify independent risk factors associated with survival in US. RESULTS: With an area under the curve (AUC) of 0.840 and 0.739, the combined ESP has diagnostic value and the ability to assess the severity of US. There was no significant difference in the survival curve between the combined ESP for the diagnosis of US and the gold standard (P > 0.05). ESI is a standalone predictor of survival in patients with US. CONCLUSION: ESP measured by CT has diagnostic values for US and its severity, as well as being a predictive value for the prognosis of US.

Point-of-care ultrasound in Management for Dyspneic Uremic Patients: a case report.

BACKGROUND: Point-of-Care Ultrasound (PoCUS) is considered as an extension of clinicians' patient care and can be integrated into daily clinical practice. Dyspnea is a common presentation in uremic patients. With the aids of PoCUS and integrated assessments of lung, heart and inferior vena cava (IVC), the etiology of dyspnea in uremic patients can be determined earlier. CASE PRESENTATION: A 67-year-old woman presented with progressive shortness of breath and bilateral legs edema for 3 weeks. The laboratory data revealed marked elevated level of serum creatinine and blood urea. A large amount of pericardial effusion was timely detected by PoCUS. Uremic pericarditis was suspected. Emergent hemodialysis was initiated and her symptoms improved. CONCLUSIONS: PoCUS is a noninvasive and cost-effective imaging modality and it has been popular in the emergency department (ED). In uremic patients presenting with dyspnea, the integration of PoCUS into traditional physical examinations help emergency physicians narrow down the differential diagnoses.

Ultrasonic image analysis of longitudinal strain in uremic patients with preserved left ventricular ejection fraction.

BACKGROUND: Patients with uremia have high cardiovascular disease morbidity and mortality despite having normal left ventricular ejection fraction (LVEF). Longitudinal strain (LS) can be associated with subtle changes in LV systolic function. The aim of this study was to use two-dimensional speckle-tracking echocardiography (2DSTE) to assess subclinical LV myocardial dysfunction and to explore strain-changing regularities in uremic patients with LVEF ≥ 55%. METHODS: The study population included 40 uremic patients and 40 healthy volunteers. 2DSTE was performed on all participants to assess peak LS in the basal, mid and apical LV (BLS, MLS and ALS) and the respective time to peak LS (T-BLS, T-MLS, T-ALS). RESULTS: BLS, MLS, and ALS were significantly decreased in the uremic group relative to healthy controls and LS increased going in a basal to apical direction in both groups. T-BLS, T-MLS and T-ALS was significantly increased in the uremic group compared with the control group. In uremic patients, T-BLS, but not T-MLS or T-ALS, was significantly delayed relative to the control group. Bivariate analysis of creatinine (Cr) or urea nitrogen and strain parameters revealed a correlation only between ALS and Cr. CONCLUSION: 2DSTE can identify LV myocardial abnormalities in uremic patients with preserved LVEF at early stage, as well as some changing regularities of LS and T-LS in the left ventricle.

Nerve cross-sectional area in advanced uremic neuropathy: A nerve ultrasound pilot study.

BACKGROUND AND PURPOSE: Uremic neuropathy (UN) is a disabling neuropathy in end-stage kidney disease (ESKD) affecting the majority of patients receiving long-term hemodialysis (HD). One previous nerve ultrasound study reported an increased cross-sectional area (CSA) of the median nerve in moderate UN, while another study found enlarged sural nerves in small-fiber polyneuropathy associated with ESKD. The present cohort study aims to analyze bilateral CSA of multiple nerves in UN. METHODS: Ten nondiabetic ESKD patients with UN on HD for at least 2 years and 10 healthy age-matched controls underwent bilateral ultrasound examinations with CSA measurements in 13 arm and leg nerve sites. Nerve conduction studies (NCS) and the total neuropathy score (TNS) were recorded. Pearson's coefficient and the Mann-Whitney U-test were used to analyze correlations and compare groups. RESULTS: ESKD patients presented advanced neuropathic symptoms (mean TNS 15.9). NCS showed significantly reduced motor and sensory amplitudes in the UN group compared to the control group, and a slightly reduced nerve CSA was observed in 5 of 13 nerve sites (p < .05); the other nerve sites were not enlarged. Sural nerve CSA (p < .05) and sensory amplitude (p < .01) were negatively correlated with the TNS. CONCLUSIONS: Nerve enlargement was not observed in the present study in advanced UN. A reduced nerve CSA observed in the sural nerve suggests an axonal loss associated with long-term HD in ESKD. During clinical workup of an acute disease of the peripheral nervous system in ESKD patients, nerve enlargement might be attributable to other causes than chronic UN.

Prognostic values of left atrial strain analyzed by four-dimensional speckle tracking echocardiography in uremia with preserved ejection fraction.

Little is known about the prognostic value of left atrial strain by four-dimensional speckle-tracking echocardiography in end-stage renal disease patients with preserved left ventricular ejection fraction. This prospective study collected clinical and echocardiographic data from 80 stable dialysis patients (mean age 57 ± 10 years; 62.5% men). All patients underwent the dedicated four-dimensional speckle-tracking echocardiography to measure LASr (peak longitudinal strain of reservoir function), LAScd (peak longitudinal strain of conduit function), LASct (peak longitudinal strain of contractile function), LASr_c (peak circumferential strain of reservoir function), LAScd_c (peak circumferential strain of conduit function) and LASct_c (peak circumferential strain of contractile function). These patients were enrolled from August 2021 to August 2023 and followed-up for 19 months (interquartile-range 15 to 20 months). The primary outcome was a composite of all-cause mortality or major adverse cardiovascular events (MACEs). The study patients were classified into event (developed mortality or MACEs) and event-free group according to the primary outcome. Multivariate Cox regression analysis was used to investigate risk factors for all-cause mortality or MACEs. The event group had lower LASr (16.4% vs. 21.2%, P = 0.0003), LASct (8.2% vs. 11.2%, P = 0.01), LASr_c (25.2% vs. 35.0%, P = 0.0004) and LASct_c (14.9% vs. 20.9%, P = 0.001) than the event-free group. Using optimal cut-off value determined by ROC curve, the less LASr (LASr < 18.5%), LASct (LASct < 8.5%), LASr_c (LASr_c < 28.5%), and LASct_c (LASct_c < 17.5%) group had a higher mortality or MACEs rate. Multivariate cox regression analyses revealed that LASr (HR = 0.81, 95% CI [0.17; 0.91], P = 0.0005, per 1% increase) and LASr_c (HR = 0.93, 95% CI [0.87; 0.98], P = 0.01, per 1% increase) were independent predictors of all-cause mortality or MACEs. Less peak longitudinal and circumferential strains of reservoir function are predictive of poor prognosis among end-stage renal disease patients with preserved left ventricular ejection fraction.

Echocardiographic evaluation of epicardial adipose tissue in non-diabetic, non-hypertensive hemodialysis patients.

PURPOSE: It has been found out that the epicardial adipose tissue (EAT) measured by echocardiography is related with various metabolic parameters. Being accepted as the new cardiovascular risk indicator, there have been few studies on EAT in relation to the patients with end-stage renal failure. In our study, we aim to evaluate EAT and carotid intima media thickness (CIMT) in non-diabetic, non-hypertensive hemodialysis (HD) patients. METHODS: Our study recruited 47 non-diabetic, non-hypertensive HD patients (22 males, 25 females, median age 54 (44.3-60.8) years) and an age-gender matched control group consisting 41 healthy subjects (17 males, 24 females, median age 52 (48-56) years). In all patients, EAT was measured by echocardiography and CIMT by ultrasonography; and routine laboratory parameters were studied. RESULTS: In our study, we obtained laboratory findings matching with the profiles of uremic patients among HD patients and CIMT values of HD patients are significantly higher than that of the control group [0.79 (0.64-0.93) vs. 0.6 (0.53-0.68) p < 0.001], and EAT values are similar [0.5 (0.33-0.6) vs. 0.4 (0.4-0.53) p > 0.05]. CONCLUSIONS: EAT is not a cardiovascular risk indicator in HD patients without diabetes mellitus and hypertension. Besides, echocardiographic measurement of EAT is easy, non-invasive, cheap and credible method.

Clinical value of ultrasound in adult Wilms' tumor patient with uremia: A case report and literature review.

RATIONALE: Wilms' tumor (WT) is the most common pediatric kidney malignancy and is rarely found in adults. Nonspecific clinical symptoms and imaging features often lead to delayed diagnosis or misdiagnosis of adult WT, resulting in poor clinical outcomes. Ultrasound (US), as an efficient and noninvasive examination method, has been widely used in clinical diagnosis and treatment. Therefore, various US evidence is meaningful to improve understanding of adult WT characteristics in ultrasound. PATIENT CONCERNS: A 45-year-old female patient with uremia (regular hemodialysis for 13 years) with painless gross hematuria was diagnosed with a right kidney tumor penetrating to the lung. Preoperatively, B-mode ultrasonography showed an ill-defined hyperechoic mass in the right kidney, which revealed an unclear border, uneven internal echoes, and calcification. Besides, the internal blood flow signal of the tumor was detected. Contrast-enhanced ultrasound (CEUS) showed an uneven hyper-enhancement in the tumor ("fast in and slow out"). Contrast-enhanced computed tomography of the kidney indicated a similar result as the CEUS. Moreover, the chest CT identified multiple pulmonary metastatic nodules. DIAGNOSES: An ultrasound-guided percutaneous core needle biopsy of the tumor proceeded to make a definite diagnosis of adult WT (epithelial type). INTERVENTIONS: The patient was treated with tislelizumab. OUTCOMES: No progress was found to date. LESSONS: We report the first case in which CEUS was performed in an adult WT patient with uremia and multiple pulmonary metastases. The features obtained by the US can help in the diagnosis of adult WT and direct further diagnostic procedures.

Preliminary study of sural nerve morphological changes in uremic hemodialysis patients using 22-MHz high-frequency ultrasound.

INTRODUCTION: The aim of this study was to evaluate the ultrasound (US) morphological changes of sural nerves (SNs) of uremic patients on hemodialysis. METHODS: Sixty-six SNs in 33 uremic patients were examined by 22-MHZ high-frequency US and routine nerve conduction studies (NCS), and 76 SNs in 38 controls were also examined. Cross-sectional area (CSA) and maximal fascicular thickness (MFT) of the SNs were measured. RESULTS: The inner parts of the SN were clearly identified in all participants. There were significant increases in CSA and MFT in the patient group (1.86 ± 0.53 mm(2) and 0.37 ± 0.08 mm, respectively) compared with the control group (1.38 ± 0.25 mm(2) and 0.32 ± 0.03 mm, respectively) (P < 0.001). Fifty-seven SNs (86.36%) had abnormal CSAs, and 51 SNs (77.27%) had abnormal MFTs in the patient group, which was higher than NCS abnormalities (66.67%). CONCLUSIONS: A 22-MHZ US can show morphological changes in the SNs of uremic patients and may be a valuable tool.

Advanced left ventricular diastolic dysfunction in uremic patients with type 2 diabetes on maintenance hemodialysis.

BACKGROUND: Diabetic nephropathy is the leading cause of end-stage renal disease (ESRD). Myocardial dysfunction may occur in patients with diabetes mellitus (DM) in the absence of coronary artery disease or left ventricular (LV) hypertrophy. Although tissue Doppler imaging (TDI) is a highly effective means of quantifying myocardial diastolic function, its differences in ESRD patients with diabetes and without diabetes remain unclear. METHODS AND RESULTS: A total of 101 ESRD patients on maintenance hemodialysis with normal LV systolic function were studied: 37 with type 2 DM and 64 without DM. Conventional echocardiography and TDI were performed to evaluate LV systolic and diastolic functions. The conventional LV systolic and diastolic echocardiographic parameters did not differ according to presence of DM, except for the left atrial size and volume index (P<0.001). The ESRD patients with DM, however, had significantly decreased mitral annular early diastolic peak velocity (e') and ratio of early to late diastolic mitral annular velocity (e'/a'; both P<0.02). Additionally, the group with DM had markedly higher estimated LV end-diastolic filling pressure (E/e'; P=0.011). CONCLUSIONS: ESRD patients with DM had advanced LV diastolic dysfunction on TDI. In ESRD patients with DM, diabetic cardiomyopathy associated with advanced LV diastolic dysfunction is observed. (Circ J 2012; 76: 2380-2385).

Assessment of left ventricular hemodynamics and function of patients with uremia by vortex formation using vector flow mapping.

A novel echocardiographic method, vector flow mapping (VFM), acquires velocity vector from color Doppler velocity data. The purpose of this study was to evaluate whether VFM could provide useful information on intracardiac flow and helpful to evaluate left ventricular (LV) function. Thirty-eight patients with uremia undergoing hemodialysis and 30 healthy volunteers were enrolled. The maximum vector velocity, maximum diameter and duration of the intracardiac vortex were measured using VFM software during systole and diastole. The maximum vector velocity of the vortex and the peak velocities at the basal septum and lateral mitral annulus measured by tissue Doppler imaging (TDI) were correlated. The maximum diameter and duration of vortex formation were significantly higher in uremic patients compared with the control group during the ejection phase (40.6 ± 7.9 cm/sec vs. 28.1 ± 3.9 cm/sec; 297.1 ± 22.1 msec vs. 145.4 ± 19.3 msec, all P < 0.001). The maximal diameters of the vortex were higher in uremic patients compared with the control group during diastole (25.6 ± 3.4 mm vs. 16.4 ± 2.1 mm; 34.3 ± 3.1 mm vs. 26.8 ± 3.9 mm; 37.5 ± 2.4 mm vs. 20.9 ± 2.1 mm; all P < 0.001). The maximum vector velocities were lower in mid-diastole and late diastole (23.6 ± 2.3 cm/sec vs. 45.2 ± 3.7 cm/sec; 31.9 ± 2.9 cm/sec vs. 54.7 ± 3.2 cm/sec, all P < 0.001). There was a correlation between the maximum vector velocity of the vortex in mid-diastole and E'/A' at the septum and lateral mitral annulus (r = 0.70, r = 0.76, P < 0.001). Vortex can be utilized to provide intracardiac dynamic information using VFM and it may be a good supplement for evaluating LV function.

The Value of CT Angiography Based on Intelligent Segmentation Algorithm for Survival of Hemodialysis Patients.

This study was to explore the application value for central venous stenosis and occlusion in hemodialysis patients under the CT angiography based on intelligent segmentation algorithm, so that patients can survive better. Spiral CT was used to examine upper limb swelling in 62 uremic hemodialysis patients at a speed of 3.8 mL/s. Nonionic iodine contrast agent was injected around the contralateral limb. The total dosage of 90-102 mL, it was scanned by intelligent trigger technology. The trigger scanning threshold was set. The monitoring point was located in the superior vena cava. CT with convolutional neural network intelligent segmentation algorithm was used to process image data. Finally, the quality of life and related biochemical levels of patients before and after hemodialysis were detected. Under the CT angiography of intelligent segmentation algorithm, 77 stenoses were found in 62 uremic patients, including 48 stenoses of the brachial vein and 17 stenoses of the superior vena cava. The correlation coefficient between CT angiography and digital subtraction angiography (DSA) imaging results of intelligent segmentation algorithm was 0.411. Segmentation effect of the algorithm in this study: automatic segmentation accuracy was greater than 79%. After hemodialysis treatment, the scores of physical fitness, pain, social function, and energy status of patients were significantly increased compared with those before treatment, and the levels of albumin, serum phosphorus, and parathyroid hormone were significantly decreased (P < 0.05). In summary, CT angiography with intelligent segmentation algorithm can obtain clear, intuitive, and complete vascular walking images, and better display subclavian vein, brachiocephalic vein, and superior vena cava. It can provide more valuable support for surgical intervention and has certain application value for better survival of hemodialysis patients.

Chondrocyte rather than osteoblast conversion of vascular cells underlies medial calcification in uremic rats.

OBJECTIVE: To investigate cell biological changes in calcified aortas of rats that experienced chronic renal failure. METHODS AND RESULTS: Vascular smooth muscle cells have the potential to transdifferentiate to either chondrocytes or osteoblasts, depending on the molecular pathways that are stimulated. Uremia-related medial calcification was induced by feeding rats an adenine low-protein diet for 4 weeks. Aortic calcification was evaluated biochemically and histochemically and with in vivo micro-computed tomographic scanning. Immunohistochemistry and RT-PCR were applied to analyze the time-dependent aortic expression of molecules involved in the segregation between the chondrocyte versus osteoblast differentiation pathway. After 4 weeks, 85% of the uremic rats had developed distinct aortic medial calcification, which increased to severely calcified lesions during further follow-up. The calcification process was accompanied by a significant time-dependent increase in the expression of the chondrocyte-specific markers sex determining region Y-box 9 (sox9), collagen II, and aggrecan and a nonsignificant trend toward enhanced core binding factor alpha 1 (cbfa1), and collagen I. The expression of the osteoblast marker osterix and both lipoprotein receptor-related protein 6 and beta-catenin, molecules of the wingless-type MMTV integration site family member (Wnt)/beta-catenin pathway induced during osteoblast differentiation, was suppressed. CONCLUSIONS: In the aorta of uremic rats, medial smooth muscle cells acquire a chondrocyte rather than osteoblast phenotype during the calcification process.

Role of the parathyroid gland vascularization index in predicting percutaneous ethanol injection efficacy in refractory uremic hyperparathyroidism.

AIMS: To evaluate the role of the quantitative vascularization index (VI) as a measure of the completeness of percutaneous ethanol injection therapy (PEIT). METHODS: A total of 37 dialysis patients with secondary hyperparathyroidism refractory to medical therapy received PEIT. We analyzed the role of a quantitative marker of parathyroid adenoma activity, i.e. VI, flow index and vascular flow index as measured by 3-dimensional Doppler ultrasound with a 3-dimensional histogram software, for all patients before treatment and at 1 month and 6 months after PEIT. RESULTS: Serum intact parathyroid hormone (i-PTH) level showed a strong positive correlation with the VI both before (p < 0.001) and after (p < 0.001) PEIT. There was no correlation between i-PTH level and the volume of the gland either before (p = 0.697) or after (p = 0.564) PEIT. One month after PEIT, 20 patients (group 1) reached the target of i-PTH ≤ 300 pg/ml and 17 patients (group 2) did not. Group 2 patients had significantly greater VI and i-PTH prior to PEIT than group 1 patients (42.23 ± 8.38 vs. 14.95 ± 8.07, p <0.001 and 1,447 ± 243 vs. 859 ± 231, p < 0.001 respectively). CONCLUSION: A higher VI indicates a higher i-PTH, and the VI may be a reliable predictor of the completeness of PEIT.

Practical preprocedure measurement to estimate the required insertion depth and select the optimal size of tunneled dialysis catheter in uremic patients.

We evaluated two methods for preprocedure predicting the insertion depth of tunneled dialysis catheter (TDC) on chest radiograph (CXR). Patients undergoing TDC insertion via right internal jugular vein were enrolled. By Method 1, the insertion depth was calculated on preprocedure CXR as the distance from the anticipated venous tip (3.5 cm below the cavoatrial junction) to the prearranged skin puncture site (1.5 cm above the right clavicle). By Method 2, the insertion depth was derived by adding the length between the skin puncture site and the upper edge of the clavicle and the length of clavicle-to-tip. The TDC was placed at the estimated insertion depth. The distance of cavoatrial junction-to-arterial tip was then measured from postoperative supine CXR. One hundred and seventy and 121 TDCs were inserted by Method 1 and Method 2, respectively, while 127 and 92 preoperative supine CXR were used for preprocedure measurement. The mean distance of cavoatrial junction-to-arterial tip was 12.055 (8.5684) [mean (SD)], 11.27 (3.3261), 9.524 (5.1590), and 10.538 (2.6956) mm. Methods of determining the insertion depth by preprocedure measurement enable successful TDC tip placement. Method 2 and using preoperative supine CXR enabled more precise and flexible insertion.

Lentiform fork sign: Uremia alone or multifactorial causation?

Neurological complications are common in patients with acute or chronic renal failure, especially when there is marked reduction in the glomerular filtration rate (GFR). One such clinical syndrome, uremic encephalopathy (UE), occurs due to widespread dysfunction of central nervous system (CNS). It manifests with myriad clinical features and usually is suggested by bedside elicitation of asterixis (flapping tremor). Symptomatic involvement of the basal ganglia manifesting as choreoathetosis and clinical and radiological resolution with hemodialysis has been reported in the medical literature, but only rarely. The present report details such a case.

Bone turnover, osteopenia and vascular calcifications in hemodialysis patients. A histomorphometric and multislice CT study.

BACKGROUND: Several classical risk factors are at the base of vascular calcifications in hemodialysis patients. Among these, according to a general opinion, also bone turnover plays a role, which, however, requires a better definition. In addition, it has been suggested that there is a relationship between primary osteoporosis and vascular calcifications. This bone biopsy-based study on a hemodialysis patient cohort is a contribution to the evaluation of these alleged relations. METHODS: This study has been carried out on a cohort of 32 patients on maintenance hemodialysis, who were subjected to transiliac bone biopsy for histomorphometric, histodynamic and bone aluminum deposit evaluation. The patients were also examined with multislice computerized tomography for quantitation of heart and coronary calcifications. RESULTS: The patients were affected by renal osteodystrophy with a wide range of bone formation rate values. A significant negative correlation was found between the rate of bone turnover and log-transformed cardiac calcification score (p < 0.003). There were also negative significant correlations between the cardiac and coronary calcification score log and trabecular number (p < 0.02 and p < 0.05, respectively), while the correlations were positive with trabecular separation (p < 0.03 and p < 0.05, respectively). However, multiregression analysis, forward method, selected only age, hemodialysis age and serum Ca as predictive variables of cardiac and coronary calcification score log, while the histomorphometric and histodynamic variables were excluded. CONCLUSIONS: In this study, in spite of the suggestive findings of the univariate statistical approach, a further multivariate analysis was indicative of a spurious association between calcification scores and both bone turnover and histomorphometric parameters of trabecular mass and connectivity. Bone turnover and trabecular mass do not appear to be prominently connected with the extent of cardiac and coronary calcifications in hemodialysis patients.

[Echocardiographic evaluation of left ventricular geometry and function in maintenance hemodialysis uremic patients].

OBJECTIVE: To assess left ventricular (LV) geometry, LV diastolic and systolic function in maintenance hemodialysis uremic patients. METHODS: Forty uremic patients and forty-five normal subjects were included in this study. LV volume, LV mass index (LVMI), relative wall thickness (RWT), LV mass and diastolic volume ratio (LVM/EDV) were measured. Mitral flow E velocity and A velocity ratio, deceleration time, mitral flow E velocity and mitral annulus Ea velocity ratio (E/Ea), pulmonary vein flow S velocity and D velocity ratio, atrial flow reversal velocity of pulmonary vein flow, mitral inflow propagation velocity, left atrium volume (LAV) and pulmonary artery systolic pressure (PASP) were determined for diastolic function evaluation. LV ejection fraction (LVEF) and single volume (SV) were derived from 3D echocardiography, systolic velocity of mitral valve annulus (Sa) by pulse tissue Doppler imaging (TDI) were used to evaluate systolic function. The time to peak systolic velocity (Ts) and early diastole velocity (Td) of LV 12 segments were measured using TDI. The maximal difference of Ts and Td (Ts-Dif and Td-Dif) were calculated to assess LV systolic and diastolic asynchrony. RESULTS: RWT, LVMI and LVM/EDV were significantly increased in uremic patients. There were 50% concentric, 17.5% eccentric hypertrophy and 17.5%concentric remodeling, respectively in uremic patients. The indices for LV diastolic function (E/Ea, LAV and PASP) were significantly higher in uremic patients than those in control subjects (P < 0.01). About 85% of the diastolic dysfunction in uremic patients presented as impaired relaxation pattern and 32.5% as increased filling pressure. LVEF and SV were similar between uremic patients and control subjects. Sa was significantly lower in uremic group than that in controls (P < 0.05). Ts-Dif was similar between the 2 groups while Td-Dif was significantly higher in uremic patients than control subjects (P < 0.05). CONCLUSION: LV hypertrophy, LV mass increase and LV diastolic dysfunction were the major characteristic of myocardial injury in uremia patients.

Assessment of the left ventricular function in patients with uremia using layer-specific 2-dimensional speckle tracking echocardiography.

The aim of this research is to evaluate the longitudinal and circumferential systolic function of the left ventricle with different configurations from endocardium, midmyocardium, and epicardium, respectively, in patients with uremia using layer-specific 2-dimensional speckle tracking echocardiography (2D-STE).According to the different left ventricular (LV) configurations, 119 patients with uremia were divided into 2 groups: LV normal group (LVN group, n = 63) and LV hypertrophy group (LVH group, n = 56). In all, 66 healthy volunteers were selected as controls. High-frame rate 2-dimensional images were recorded from the apical 4-chamber view, apical 2-chamber view, parasternal LV long-axis view, and mitral annulus, papillary muscle, and apical levels of the parasternal LV short-axis view during 3 consecutive cardiac cycles. The peak systolic longitudinal strain (LS) and circumferential strain (CS) were measured in the endocardium, midmyocardium, and epicardium.In the 3 groups, the endocardium had the highest LS and CS, whereas the epicardium had the lowest LS and CS; the LS and CS of each group gradually decreased from the endocardium to the epicardium in all the 3 sections; the LS and CS of the myocardial layers were kept gradient features, namely, endocardium > midmyocardium > epicardium. The LS of the endocardium in the LVN and LVH groups was significantly lower than that in the control group (P < .05). The LS of the midmyocardium and epicardium in the LVH group were significantly lower than those in the control group (P < .05). The LS of the endocardium significantly decreased in the LVH group compared with that in the LVN group (P < .05). The CS of the endocardium and midmyocardium in the LVH group significantly decreased compared with those in the control and LVN groups (P < .05). There were no significant differences in the CS between the LVN and control groups (P > .05).In patients with uremia, the longitudinal and circumferential systolic function in 3 myocardial layers of the LVH group, and the longitudinal systolic function in endocardium of the LVN group were found significantly impaired by layer-specific 2D-STE.