Application of VVI layered strain technology to analyze changes in left ventricular myocardial motion in patients with uremia

TL;DR

This study uses a new imaging technique to analyze heart muscle movement in patients with kidney disease, revealing differences in heart function between patients with and without heart enlargement.

Contribution

The study introduces the use of VVI layered strain analysis to detect subtle myocardial motion changes in uremic patients, particularly in those with left ventricular hypertrophy.

Findings

LVH and LVN groups showed impaired basal and mid-segment global strain compared to controls.

LVH patients had reduced strain in specific heart regions compared to LVN patients.

Certain strain measurements correlated with hemoglobin levels and predicted myocardial remodeling.

Abstract

Velocity vector imaging (VVI) stratified strain analysis was used to assess circumferential strain across myocardial layers in uremic patients using a 16-segment left ventricular model.

Data were accessed for research purposes from 1/5/2025–1/6/2025. Sixty hemodialysis patients were divided into left ventricular hypertrophy (LVH, n = 30) and normal LV conformation (LVN, n = 30) groups based on LV mass index, alongside 27 healthy controls (CON). Clinical and echocardiographic data were analyzed, with VVI quantifying systolic circumferential strain (CS) in endocardial (Endo), mid-myocardial (Myo), and epicardial (Epi) layers.

The LVH and LVN groups exhibited significant differences compared to the CON group in SBP, Hb, BUN, Scr, eGFR, and hsCRP levels (P < 0.001). Hb levels were uniquely reduced in LVH versus LVN (P < 0.05). Both uremic groups had larger cardiac dimensions (LAD, LVPTW, IVST, LVIDd, LVIDs) than CON (P < 0.001), but similar LVEF (P > 0.05). Basal and mid-segment global strain were impaired in LVH/LVN (P < 0.05), while apical strain differences were only significant in the Epi layer. LVH showed reduced anteroseptal basal strain (Endo/Myo/Epi-2CS) and inferoseptal basal (Endo/Myo-3CS) and anterolateral mid (Epi-12CS) strain versus LVN. Anteroseptal (Endo/Myo/Epi-2CS) and inferoseptal (Endo/Myo-3CS) strains correlated with Hb levels (P < 0.01). Anteroseptal basal strains (Endo/Myo/Epi-2CS) and their combined values significantly predicted myocardial remodeling (AUC, P < 0.001). While Epi-3CS and its combined values (Endo/Myo/Epi-2CS) did not (P > 0.05).

The VVI layered strain technique is a precise and sensitive tool for evaluating LV myocardial motion in uremic patients.

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