INTRODUCTION Although maintenance hemodialysis (MHD) in end-stage renal disease (ESRD) appears to induce some risk factors and strengthen cardiac function, the morbidity of ESRD patients receiving hemodialysis remains high. This study aimed to identify left ventricular (LV) structural and functional abnormalities in ESRD patients on MHD using three-dimensional speckle-tracking imaging (3D-STI). METHODS Eighty-five ESRD patients with normal LV ejection fraction (LVEF >50%) participated in this study, including 55 MHD patients comprising the chronic kidney disease (CKD) V-D group and 30 nondialysis patients comprising the CKD V-ND group. Thirty age- and sex-matched control participants who had normal kidney function were enrolled as the N group. Conventional echocardiography and 3D-STI were conducted, and global longitudinal strain (GLS), global circumferential strain (GCS), global area strain (GAS), and global radial strain (GRS) values were measured. RESULTS No substantial differences in two-dimensional LVEF were observed among the three groups, and LV hypertrophy was the most common abnormality in patients with ESRD, irrespective of whether they had received or not received MHD. There were no significant differences in the 3D LV mass index between the CKD V-ND and N groups (P > 0.05). Conversely, the 3D LV mass index was considerably higher in the CKD V-D group than in both the N and CKD V-ND groups. The GLS, GAS, and GRS values were significantly lower in the CKD V-ND group than in the N group (P < 0.05). Furthermore, the CKD V-D group had significantly lower GLS, GCS, GAS, and GRS values than the N and CKD V-ND groups (P < 0.05). The interventricular septal thickness and E/e' ratio were independently associated with LV strain values in all patients with ESRD. CONCLUSIONS MHD can exacerbate LV deformation and dysfunction in ESRD patients with preserved LVEF, and 3D-STI can be potentially useful for detecting these asymptomatic preclinical abnormalities.

中文翻译：

---

维持性血液透析患者的左心室功能：三维斑点跟踪成像研究。

引言 尽管终末期肾病（ESRD）的维持性血液透析（MHD）似乎会诱发一些危险因素并增强心功能，但接受血液透析的 ESRD 患者的发病率仍然很高。本研究旨在使用三维斑点跟踪成像 (3D-STI) 来识别 MHD 治疗中的 ESRD 患者的左心室 (LV) 结构和功能异常。方法 85 例 LV 射血分数正常（LVEF >50%）的 ESRD 患者参与本研究，其中 55 例 MHD 患者构成慢性肾脏病（CKD）VD 组，30 例非透析患者构成 CKD V-ND 组。三十名年龄和性别匹配且肾功能正常的对照参与者被纳入 N 组。进行常规超声心动图和3D-STI，并测量全局纵向应变（GLS）、全局周向应变（GCS）、全局面积应变（GAS）和全局径向应变（GRS）值。结果 三组之间二维 LVEF 没有观察到显着差异，左室肥厚是 ESRD 患者最常见的异常，无论他们是否接受过 MHD。CKD V-ND 组和 N 组 3D LV 质量指数差异无统计学意义（P > 0.05）。相反，CKD VD 组的 3D LV 质量指数显着高于 N 组和 CKD V-ND 组。CKD V-ND组GLS、GAS、GRS值显着低于N组（P < 0.05）。此外，CKD VD 组的 GLS、GCS、GAS 和 GRS 值显着低于 N 组和 CKD V-ND 组（P < 0.05）。所有 ESRD 患者的室间隔厚度和 E/e' 比值与 LV 应变值独立相关。结论 MHD 会加剧 LVEF 保留的 ESRD 患者的 LV 变形和功能障碍，而 3D-STI 可能有助于检测这些无症状的临床前异常。