Abstract: Objective:To  use  3D⁃STI  evaluates  the  effect  of  arteriovenous  fistula  on  the  left  ventricular  systolic function in patients with  uremia.     Methodology: A  total  of  41  patients  with  uremia  who  met  the  criteria  and  needed  to undergo fistula(internal forearm fistula)  were included. The differences of conventional echocardiographic indexes and 3D⁃ STI indexes  including  left  ventricular  global  longitudinal  strain (LVGLS),  left  ventricular  global  circumferential  strain (LVGCS), left ventricular global area strain(LVGAS), left ventricular global radial strain (LVGRS), left ventricular end⁃ diastolic volume(LVEDV), left ventricular end⁃systolic volume (LVESV)  before AVF, and 1 day, 1 month and 3 months after AVF  were  compared  respectively.  The  correlation  between  brachial  artery  flow  change,  fistula  diameter  and  left ventricular strain change of 3D⁃STI was analyzed at 1 day after AVF.  To explore  whether 3D⁃STI  before  and after  AVF is more  sensitive  than  conventional  echocardiography  in  evaluating  left  ventricular  systolic  function  in  uremic  patients. Results:(1)  Conventional echocardiography showed that the left ventricular ejection fraction(LVEF)  and Sm, two indexs reflecting left  ventricular  systolic  function,  had  no  significant  differences  at  1  day,  1  month  and  3  months  after  AVF compared with that before AVF(P<0.05). (2)  3D⁃STI showed that LVGLS, LVGCS, LVGAS and LVGRS, which reflect the left ventricular systolic function, were significantly different at 1 day after AVF compared with before AVF(P<0.05), but had no significant differences at 1 month and 3 months after AVF compared with before AVF(P<0.05).  (3)  Pearson correlation analysis results showed that brachial  artery  flow  at 1  day  after  AVF  was  positively  correlated  with  LVGLS(r = 0.34, P<0.05), while brachial artery flow at 1 day after AVF was not correlated with LVGCS, LVGAS and LVGRS(r = 0.23, 0.27,- 0.22,  P > 0.05).  There  was  no  correlation  between  fistula  diameter  and  LVGLS,  LVGCS,  LVGAS  and LVGRS (r = 0.09,-0.03, 0.00, 0.10, P> 0.05).  (4)  Receiver  operating  curve  (ROC)  analysis  showed  that  the  area under the curve of LVGLS was 0.727(P<0.001, 95% CI 0.61- 0.84).  With LVGLS = - 11.5%  as the cut⁃off value, the sensitivity and specificity  of  LVGLS  in  predicting  early  left  ventricular  systolic  function  after  AVF  were  78%  and  68%. Conclusion:3D⁃STI  is  more  sensitive  than  conventional  echocardiography  in  early  assessment  of  left  ventricular  systolic function in patients with uremia at 1 day after AVF, and LVGLS can be a sensitive index for early detection of myocardial function after AVF. The degree  of  change  in  brachial  artery  flow 1  day  after  AVF  is  a  factor  affecting  the  left  ventricular systolic function in uremic patients.

Key words: three?dimensional , speckle?tracking , echocardiography    , arteriovenous , fistula    , uremia    , left , ventricular function