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Objective:To investigate the influence of indoxyl sulfate(IS), a typical protein-bound uremic toxin, on left atrial (LA) functional strains using three-dimensional speckle tracking echocardiography (3DSTE).Methods:From May 2019 to January 2020, 128 individuals were consecutively enrolled, including 37 healthy controls and 91 patients, who received maintenance hemodialysis (MHD) in the blood purification center of Zhongshan Hospital affiliated to Fudan University. Conventional echocardiographic parameters and 3DSTE datas of LA were obtained on interdialytic days.LA reservoir, conduit and contraction strains (LASr, LAScd and LASct) were calculated and compared. IS concentration in plasma was assessed by high-performance liquid chromatography tandem mass spectrometry in the MHD cohort.According to the IS concentration, the MHD group was divided into high and low IS (HI and LI) groups. The LA data were also compared between the two groups and linear regression analysis was used to identify independent impact factors of LA strains.Results:Compared to the control group, MHD group had markedly enlarged LA volumes( P<0.05). With regard to the LA phasic strains, both of LASr and LAScd were decreased( P<0.05), while LASct remained unchanged( P>0.05). Compared to the LI group, LASr, LAScd and LASct of the HI group were significantly decreased(all P<0.05). Correlation analysis showed IS concentration correlated well with LASr( rs=-0.674, P<0.001), LAScd( rs=0.454, P<0.001) and LASct( rs=0.376, P<0.001). After adjustment of age, systolic blood pressure, left ventricular mass index(LVMI), and pulmonary systolic pressure, IS concentration remained independently associated with LASr (β=-0.206, 95% CI=-0.353--0.059, P=0.007). Conclusions:In MHD patients, LA is enlarged, and its reservoir function and conduit function are impaired.LA strains derived from 3DSTE are independently related to the IS concentration in plasma, which can be used for the monitoring and evaluation of IS induced cardiac injury.
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Objective To discuss the clinical value of real-time myocardial contrast echocardiography ( RT-MCE) on quantitative assessing myocardial perfusion in patients with coronary slow flow ( CSF ) . Methods CSF group contained 14 patients with CSF and 15 cases with normal coronary angiography ( CAG) were involved as control group . The 2D echocardiography and RT-MCE images from standard 3 apical views ( 4-chamber ,2-chamber ,and long-axis) were acquired . All images were digitally stored on hard disks for offline analysis by QLab software . The RT-MCE parameters included myocardial blood volume ( A) , myocardial blood veloity ( β) ,myocardial blood flow ( MBF) were used to predict the impairment of myocardial perfusion in the two groups . Results In CSF group ,the value of β and MBF in abnormal segments were significantly lower than those in normal segments ( P < 0 .001) . There was no significant difference of A between the abnormal segments and the normal segments in CSF group ( P > 0 .05 ) . Compared to the control group ,the value of β and MBF were significantly lower in abnormal segments of CSF group( P < 0 .001) . Comparing the normal segments of two groups ,there was no significant difference in the values of A ,β and MBF ( P > 0 .05) . ROC curve analysis showed the AUC of β was the biggest ( AUC = 0 .867 , P < 0 .001 ) , and when the cut-off value was 1 .34 , the impairment of myocardial microcirculation was best predicted ( sensitivity ,79 .6％ ;specificity ,77 .4％ ) . Conclusions The myocardial perfusion in patients with CSF can be appraised by RT-MCE quantitatively . The value of β can identify the early impairment of myocardial microcirculation perfusion in patients with CSF and has the promising prospect of clinical diagnosis .