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. 2020 Mar 10;21(1):89.
doi: 10.1186/s12882-020-01742-8.

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

Jing Zhu  1 , Fei Shi  1 , Tao You  1 , Chao Tang  1 , Jianchang Chen  2
Affiliations

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

Jing Zhu et al. BMC Nephrol. .

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.

Keywords: Diastolic dysfunction; Strain rate; Two-dimensional speckle tracking imaging; Young peritoneal dialysis patients.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Left ventricular longitudinal diastolic strain rate curves during early diastole (DSrE), late diastole (DSrA) and the isovolumic relaxation period (DSrIVR) obtained from the 2-chamber views. (a was the control group and b was the PD group)
Fig. 2
Fig. 2
a showed the correlation of DSrE with E/A, and b showed the correlation with LVPWT
Fig. 3
Fig. 3
Contour plot showing the correlation among DSrE with E/A, LVPWT. The vertical axis represents E/A, and the horizontal axis represents LVPWT. The results showed that higher E/A was consistently associated with higher DSrE after controlling for the association between E/A and LVPWT. The LVPWT was higher and more diversified in PD patients than in the healthy control group. The patients showed E/A with lower level and distribution width regarding the control group
See this image and copyright information in PMC

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