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

Abstract

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