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

Uremic patients with and without LVH showed significant differences from healthy controls in multiple clinical parameters.

• Both LVH and LVN groups differed significantly from CON in SBP, Hb, BUN, Scr, eGFR, and hsCRP levels (P < 0.001)
• Hemoglobin (Hb) levels were uniquely reduced in LVH versus LVN (P < 0.05), suggesting more severe anemia in the hypertrophy group
• Study included 60 hemodialysis patients (LVH n=30, LVN n=30) and 27 healthy controls
• Groups were divided based on LV mass index

Both uremic groups had larger cardiac dimensions than controls but preserved left ventricular ejection fraction.

• LVH and LVN groups had larger LAD, LVPTW, IVST, LVIDd, and LVIDs compared to CON (P < 0.001)
• LVEF was similar across all three groups (P > 0.05)
• This indicates structural remodeling occurs in the absence of systolic dysfunction as measured by conventional LVEF

Basal and mid-segment global circumferential strain was impaired in both uremic groups across myocardial layers.

• Basal and mid-segment global strain were impaired in both LVH and LVN groups compared to CON (P < 0.05)
• Apical strain differences were only significant in the epicardial (Epi) layer
• VVI quantified systolic circumferential strain (CS) in endocardial (Endo), mid-myocardial (Myo), and epicardial (Epi) layers using a 16-segment LV model

LVH patients showed more pronounced regional myocardial strain impairment compared to LVN patients.

• LVH showed reduced anteroseptal basal strain across all layers (Endo/Myo/Epi-2CS) versus LVN
• LVH also showed reduced inferoseptal basal strain in Endo and Myo layers (Endo/Myo-3CS) versus LVN
• LVH showed reduced anterolateral mid epicardial strain (Epi-12CS) versus LVN

Anteroseptal and inferoseptal basal circumferential strains correlated with hemoglobin levels in uremic patients.

• Anteroseptal strains (Endo/Myo/Epi-2CS) correlated with Hb levels (P < 0.01)
• Inferoseptal strains (Endo/Myo-3CS) also correlated with Hb levels (P < 0.01)
• This suggests anemia may contribute to regional myocardial dysfunction in uremic patients

Anteroseptal basal strain values significantly predicted myocardial remodeling, while certain other strain measures did not.

• Anteroseptal basal strains (Endo/Myo/Epi-2CS) and their combined values significantly predicted myocardial remodeling (AUC, P < 0.001)
• Epi-3CS and its combined values (Endo/Myo/Epi-2CS) did not significantly predict myocardial remodeling (P > 0.05)
• ROC curve analysis with AUC was used to assess predictive value