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. 2025 Jul;42(7):e70243.
doi: 10.1111/echo.70243.

Noninvasive Left Ventricular Pressure-Strain Loop for Assessment of Myocardial Work in Hemodialysis in Patients With Chronic Kidney Disease

Yunxiang Miao  1 , Lin Fan  1 , Bingyuan Zhou  1 , Yuping Liao  1 , Ying Yin  2
Affiliations

Noninvasive Left Ventricular Pressure-Strain Loop for Assessment of Myocardial Work in Hemodialysis in Patients With Chronic Kidney Disease

Yunxiang Miao et al. Echocardiography. 2025 Jul.

Abstract

Objective: To explore the value of a novel echocardiographic measure-left ventricular pressure-strain loop (LV-PSL) for assessment of patients with chronic kidney disease by comparing the changes before and after hemodialysis (HD).

Methods: A total of 117 patients undergoing regular hemodialysis were recruited. Global longitudinal strain (GLS) combined with cuff blood pressure measurement is used to calculate the global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE). The differences in echocardiographic parameters before and after hemodialysis on the same day were compared. Additionally, 50 healthy individuals were included as the control group.

Results: Compared with the control group, both the pre-HD and post-HD groups exhibited significantly lower GLS and GWE (pre-HD: p = 0.006 and p = 0.000, respectively; post-HD: p = 0.000 and p = 0.000, respectively). In contrast, the pre-HD group had significantly higher values in PSD, GWI, GCW, and GWW (p = 0.000 for PSD and GWW; p = 0.001 for GWI and GCW). Notably, the post-HD group also had higher values in PSD and GWW compared to the control group (p = 0.000 for both), while no significant differences were observed in GWI and GCW between the post-HD and control groups (p = 0.247 and p = 0.134, respectively).

Conclusions: The LV-PSL parameters are capable of effectively assessing myocardial work in HD patients. Moreover, these parameters offer novel reference indicators for evaluating volume load and left ventricular myocardial function in HD patients.

Keywords: hemodialysis; myocardial work; pressure‐strain loop; speckle tracking imaging.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Flow chart of the study with inclusion and exclusion criteria.
FIGURE 2
FIGURE 2
Bull's eye maps of longitudinal global strain for pre‐hemodialysis (Panel A), post‐hemodialysis (Panel B), and normal control (Panel C).
FIGURE 3
FIGURE 3
Comprehensive analysis of myocardial work index and work efficiency. (A) Pre‐hemodialysis; (B) post‐hemodialysis; (C) normal control. (a) Left ventricular pressure‐strain curve (X‐axis: strain; Y‐axis: left ventricular pressure). (b) Bull's‐eye plots of segmental myocardial work. (c) Color coding (green: global constructive work; blue: global wasted work). (d) Specific myocardial work parameter values.
See this image and copyright information in PMC

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